Helping Employees Manage Inflammatory Bowel Disease With Confidence

Helping Employees Manage Inflammatory Bowel Disease With Confidence

Inflammatory Bowel Disease (IBD), including Crohn’s disease and ulcerative colitis, can affect every part of daily life. From managing symptoms to keeping up at work, employees living with IBD often face ongoing challenges—along with the high cost of specialty medications.

Univera Healthcare focuses on clear, practical solutions that support members while helping employers manage the cost of care.

Coordinated Care That Makes Sense

When medical and pharmacy benefits work together, care feels simpler and more consistent. Univera Healthcare coordinates these benefits to help reduce confusion, support appropriate treatment, and improve the overall member experience.

This connected approach also helps support preventive care. When clinically appropriate, members may have access to Cologuard®, an at-home colorectal cancer screening option that can be completed without visiting a doctor’s office. Preventive screenings like this can help identify issues earlier and support better long-term outcomes.

Across the industry, employers are seeing how colonoscopy pricing and shifting care settings are contributing to rising healthcare costs. Analyses from recent national studies highlight that a significant portion of this spending could be avoided with smarter use of preventive screening options. Non-invasive tests like Cologuard® have already shown meaningful impact—about $9 million in savings in 2024—with continued growth expected as more individuals use their preventive benefits. For employers offering plans through Univera Healthcare, encouraging these can support early detection, improve member health, and help manage long-term costs.

Thoughtful Strategies to Manage High-Cost IBD Care

Our approach to IBD management balances clinical oversight with cost awareness, helping ensure members receive the care they need without unnecessary expense.

Key strategies include:

1. Condition-Based Formulary Design
   Preferred medications are selected based on their approved use for specific inflammatory conditions.
   
2. Prior Authorization Requirements
   Most specialty inflammatory medications require prior authorization to confirm diagnosis and alignment with clinical guidelines.
   
3. Medical and Pharmacy Benefit Alignment
   For medications covered under both benefits, coverage is directed to the most cost-effective option when appropriate.
   
4. Site of Care Management*
   Members receiving infusions at high-cost locations may be offered alternative settings, such as home infusion, for select therapies.
   
5. Specialty Copay Assistance Programs*
   Programs like SaveOnSP® and HelpScript® may help reduce out-of-pocket costs for eligible specialty medications.
   
6. Biosimilar Use
   Univera Healthcare supports biosimilars to improve affordability, expand access, and encourage medication adherence. Biosimilars are included across all eligible drug categories, including alternatives to Actemra, Remicade and Humira.
   
7. SafeGuardRx® Programs
   These programs help capture available manufacturer savings and manage spending for certain high-cost therapies.

Personalized Support for People Living With IBD

IBD affects everyone differently. Univera Healthcare supports personalized care plans that consider each member’s health needs, daily life, and long-term goals.

Vitalize℠ Platform*

Vitalize gives members access to digital tools that support healthier habits and overall wellbeing. Powered by Personify Health, the platform helps employees focus on the areas of health that matter most to them.

Members also have access to FoodSmart, a nutrition platform that offers:

• Personalized nutrition guidance
• Recipes tailored to dietary needs and preferences
• Tools to help plan meals and grocery shopping

Support for Complex and Ongoing Conditions

High-Cost Claimant Support

Members with complex or high-cost conditions receive focused outreach and coordinated care to support better outcomes. In 2024, pharmacy interventions contributed to more than $513,000 in medication cost savings and cost avoidance².

Care Management Services

Care managers work closely with members and providers to support preventive care, medication adherence, and condition management.

Univera Healthcare’s care teams—including nurses, pharmacists, dietitians, and social workers—work together to provide compassionate, consistent support.

Members may also receive support from specialty pharmacists at Accredo who focus on inflammatory conditions.

Helpful Tools and Everyday Support

HealthWise® Knowledgebase

Members can access reliable, easy-to-read health information through the online member portal.

Wellframe® App

The Wellframe app provides convenient access to:

• Secure messaging with a care manager
• Personalized health plans
• Medication reminders
• Access to dietitians and educational resources

A Practical, People-Focused Approach for Western New Yorkers

By coordinating care, managing costs thoughtfully, and keeping members at the center, Univera Healthcare helps employers offer meaningful support for IBD—while helping employees feel more confident in managing their health.

Disclaimer
*Program eligibility may vary by funding arrangement. A shared savings fee or buy-up may also be associated with the program
1 2018-2024 data provided by Personify Health    
2 Cost savings based on 2024 claims experience for members engaged in CM   
3 Management Outcomes data based on 2024 experience for Commercial members engaged in CM/DM based on 2024 researched cost avoidance estimate of $1,500 (those with “Other” conditions)
4 2024 Health Plan Data   
SaveOnSP is an independent company that offers specialty coinsurance assistance services for certain specialty prescription drugs to Univera Healthcare members. 
Univera Healthcare has contracted with Expion Health Company, an independent company, to provide HelpScript program benefits to our members. 
Personify Health is an independent company and offers a digital wellbeing service on behalf of Univera Healthcare 
Healthwise is an independent company that provides condition and disease management education to Univera Healthcare members.  
Wellframe is an independent company that provides a health and wellness support mobile app to Univera Healthcare members