Affordability issues and the need for a reimbursement process of advanced therapy for inflammatory bowel diseases in...

Inflammatory bowel disease (IBD) is an aggressive relapsing condition that can develop at a young age and carries a high lifetime risk of medical expenses. Patients with moderate-to-severe Crohn's disease or Ulcerative colitis need biologic therapy for induction and maintenance of remission. The cost of treating these has moved from hospitalization and surgery to biologics, which are partly reimbursed. This review identifies that a handful of insurance companies provide daycare coverage for the biologic infusion, while the injections get reimbursed only on 24-hour admission in India. This varies from patient to patient and from one insurance company to another. The biosimilars of anti-TNFs drive savings but not overall costs. Patients are made to accept substantial costs through deductibles, copayments, and coinsurance. While insurance partially covers the financial risk, healthcare in IBD remains affordable to only some. The manufacturers need to comprehend payers' perspectives to deliver the best possible patient outcomes. The pricing strategies should be indication-specific/volume-based pricing. Small molecules adoption has the potential to disrupt infusion-based reimbursement policies by shifting care to pharmacy-based models, improving access for rural populations. There is a need to implement universal health coverage post which the mortgage model can be used to spread the cost of biologics over time in IBD. The payers' perspective must be considered while determining the cost of the product and include patients in healthcare policy decision-making.