Pharmaceuticals are one of the faster growing segments of the healthcare sector in India and likely to account for almost 30 % of all healthcare spending by 2025. Buoyed by the increased incidence of chronic diseases, and an enhanced propensity to adopt expensive pharma therapies (most of them in an outpatient setting, or at home), pharma companies are launching a large number of patented drugs, as well as biosimilars. Most of these new launches will involve expensive drugs which will be administered over a longer term (6 months and above) and will likely bring with side-effects which will require to be managed as well through a process involving education, counselling and support. Vidal Health has done some path breaking work with both multinational, as well as top Indian manufacturers of world class pharma products.
Insurance solutions for high priced pharma therapiesRead More
Typically, health insurance policies written by insurers in India have tended to exclude pharma therapies, unless consumed during hospitalisation, during a 30-day pre-hospitalisation or a 60-day post hospitalisation period. This adversely affects effective pharma therapies that do not involve any hospitalisation (for instance, administered in an out-patient setting, or at home). Over the last couple of years, Vidal Health has helped pharma companies effectively deal with this situation.
Financial solutions for high-priced pharma therapiesRead More
Despite insurers’ willingness and enthusiasm to expand coverage to include pharma therapies, sometimes the extent of coverage as measured by the sum insured can be a limiting factor. Most Indians carry policies that insure low sums, which might not be adequate to cover some of the more expensive therapies—specifically in areas like oncology. In the event of the therapy duration being limited to 12-15 months, it may be possible to provide financial solutions that allow such individuals to avail themselves of unsecured loans to pay for therapy and then repay the same via EMI over a 60-month period. For individuals without any insurance, this might be a useful alternative to use up their own funds that might be deployed elsewhere or earmarked for other use. Vidal Health has excellent relationships with financing agencies like banks and other financial services companies. They can help structure programmes that bring together the pharma company, the person being treated and the financing agency to create convenience to the individual, without compromising the risk of repayments.
Expanding benefits and policy designRead More
As insurers seek to expand coverage, there is an opportunity to engage with them to represent why coverage for certain therapies would be good for multiple stakeholders. This requires a co-ordinated approach that brings together the insurers, insurance brokers, policy makers and industry bodies. This helps evaluate and recommend inclusion of relevant therapies into insurance coverage—irrespective of location or mode of administration. Vidal Health has demonstrated expertise in this space and has the capabilities to manage such initiatives. It is already driving such efforts for multiple leading pharma companies across therapy areas.
Programme administrationRead More
In order to mitigate the impact of the additional financing costs to be incurred by an individual, pharma companies have the opportunity to enroll them in empowerment programmes that can deliver savings (that may compensate for the financing costs) linked to their adherence to therapy. Enrollment in such programmes will also allow engagement with the individual over the entire tenure of the loan and help mitigate the possibility of loan default. Vidal Health has the expertise to design, implement and run such programmes on behalf of pharma companies.
Helplines for insurance queriesRead More
In the case of covered therapies for which individuals would pay upfront and submit bills to insurers for reimbursement, there is a lack of awareness about the particular therapy being already included in the coverage. By providing a helpline where individuals could call to check their eligibility, Vidal Health provides customers of pharma companies the ability to ascertain coverage for specific treatments and make their purchase decisions accordingly.