Inflammatory bowel disease (IBD) is one of the most costly and complex conditions facing employers and health plans today. But the biggest cost driver often isn’t the condition itself, it’s how it gets treated.
Biologic therapies like Humira and Stelara can provide meaningful relief for people with Crohn’s disease and ulcerative colitis. But when symptoms escalate or go unmanaged early, care becomes more complex, more expensive, and much harder on members.
And while biologics are part of the solution, they’re not a substitute for a comprehensive, proactive approach to digestive health.
Why IBD costs spike
Biologics are often essential for managing more complex IBD needs, but they come with a steep price tag. Costs can exceed $22,000 per member per year, and in some cases, reach over $100,000. But the overspend isn’t due to overuse. It’s due to under intervention when care gaps allow symptoms to escalate before evidence based treatments are introduced.
Across both employer sponsored and plan managed care, digestive conditions often go underdiagnosed, delaying access to structured, whole person support. Research shows adults with Crohn’s disease experience diagnostic delays of 2 to 26 months, while for ulcerative colitis, delays range from 2 to 12 months.
These delays are costly. Studies show:
- 66%* of ED visits for GI symptoms result in hospitalization.
- The average annual cost for someone with a digestive disease is $17,200.
Without early intervention, members are more likely to experience:
- Symptom flare-ups and situations where medications stop working as well.
- Emergency department visits and avoidable hospitalizations.
- Poor medication adherence due to lack of coordinated support (for example: nutrition, behavioral health).
This is where employer costs accelerate, not because members need unnecessary care, but because they didn’t get the right support early.
Lowering biologics costs without compromising care
Reducing coverage for GI medications might seem like a short-term savings strategy. But in practice, it often leads to higher downstream costs and member dissatisfaction.
Avoidable ED visits, missed workdays, and symptom relapse can outweigh any savings from limiting therapy access. Instead, leading employers and health plans are shifting to a model that emphasizes smarter use of biologics, not less use.
That means moving from reactive treatment to a coordinated approach that:
- Match the right therapy to the right member at the right time.
- Wraps biologics with support members need including biosimilar education, coaching from dietitians, and simple tools that help them stick with treatment.
- Tracks outcomes continuously so care plans evolve with the member.
What smarter IBD care can deliver
When members receive timely, coordinated support, the results speak for themselves. One health plan working with Cylinder saw:
$9,900
in savings per IBD patient per year.
Fewer
ED visits and hospitalizations.
No
reductions in medication access.
These outcomes are possible because of earlier engagement, proactive care, and a team based approach, not because of restrictive formularies.
Want to better understand what’s driving biologics costs?
Recent research explores how fragmented care, delayed diagnosis, and reactive treatment are leading to rising IBD costs, and what employers and plans can do to change that trajectory.
Inside, you’ll find:
- Cost benchmarks for biologics and high acuity care.
- Data on diagnostic delay and its long term impact.
- Smarter strategies for supporting members on therapy.
- Real world case study with measurable outcomes.
Read the full research
to understand what’s driving IBD costs, and how employers can make
digestive care work better for your population.
* Weiss, A. J., & Jiang, H. J. (2021). Most frequent reasons for emergency department visits. Agency for Health Care Research and Quality.
