Health insurance is increasingly being recognized by the Government of India as a necessary provision for the health of our population. While spending on health by the Government in India is one of the lowest in the world, it has been gradually increasing in recent years. However, the majority of the Indian population still does not have any form of health coverage.
Retinal disorders are among the most important causes of vision loss in India. Intravitreal anti-vascular endothelial growth factor (VEGF) injections are a proven treatment for these diseases. However, the need for repeated injections and the high associated cost burden, coupled with the lack of insurance coverage for injections makes it financially untenable for the majority of our patients to persist with treatment recommendations. The average number of intravitreal injections taken by patients per year is well below the recommended regimen by various studies and society guidelines, thereby leading to suboptimal visual outcomes in the real world. A survey conducted by the Vitreoretinal Society of India (VRSI) highlighted the challenges for access and adherence to treatment, with affordability (78% of respondents) being the major reason for the lack of initiation and continuation of therapy.
Recently, the Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines, effective from October 2020, in which they have recommended “that intravitreal injections cannot be excluded” from insurance. This has resulted in some traction in the reimbursement of intravitreal injections. However, challenges in implementation exist, and there is a lack of clarity on the limits of coverage per anti-VEGF injection, annual caps for injections, and a number of total injections covered under policies. Physicians need to work closely with the insurance companies to increase awareness about the chronic nature of retinal diseases, and the various treatment protocols employed. Injection claims must be serviced without administrative red tape, within the limits of the policy, once the science behind these recommendations is conveyed to them. All ophthalmologists should be aware of the reimbursement for anti-VEGF injections and encourage their patients to seek these out. There is also a need for a patient helpline that will transparently inform patients about the coverage expected from their policies.
The cost-effectiveness of various procedures should also be considered by ophthalmologists when considering intravitreal injections. A cost-effectiveness calculator can show the average out-of-pocket expense for a patient per injection over 1 year after adding direct and indirect costs of the procedure.
In conclusion, all ophthalmologists should be aware of the available insurance coverage for anti-VEGF injections as per the recent IRDAI guidelines. However, additional training of all the stakeholders and continued dialogue with insurance companies is required to increase the utilization of this important inclusion in the guidelines. We hope that, as with cataract surgery, anti-VEGF injections will receive universal insurance coverage and will benefit millions of Indians in the years to come.
About the author
Dr Raja Narayanan
Dr. Raja Narayanan is currently Director of Retina Institute, and Director of Suven Clinical Research Centre, L.V. Prasad Eye Institute. He is also the Principal Investigator of Indian Health Outcomes, Public Health and Economics Research Centre (IHOPE), funded by India Alliance. He is also the Honorary Secretary of Vitreoretinal Society of India. He completed his basic medical education from Delhi University, followed by a residency in ophthalmology from Guru Nanak Eye Center, New Delhi. He was a Fellow in Medical Retina, and Clinical and Research Fellow in Vitreo-Retinal Diseases, at the Department of Ophthalmology, University of California, Irvine, USA. He is currently Adjunct Associate Professor of Ophthalmology at the University of Rochester, New York. He received the Senior Honor Award from the American Society of Retina Specialists in 2015, and International Ophthalmologist Education Award at the 2007 American Academy of Ophthalmology meeting, New Orleans. He has published widely in peer-reviewed journals, written book chapters and is a reviewer for many journals such as Investigative Ophthalmology & Visual science, Retina, Journal of Cataract and Refractive Surgery, Archives of Ophthalmology, European Journal of Ophthalmology and Current Eye Research. He is on the Editorial Board of PLOS ONE and International Journal of Retina and Vitreous.
Dr. Sabyasachi Sengupta
Dr. Sabyasachi Sengupta is the founder and director of Future Vision Eye Care and Research center Mumbai where he practices as a consultant vitreoretina surgeon. He is also the founder and director of Sengupta's Research Academy, a comprehensive portal providing online lectures on research methodology and services to assist manuscript preparation. He is the current Associate Editor of the Indian journal of Ophthalmology. He completed a research – cum – clinical fellowship in surgical vitreoretinal disorders at the prestigious Sankara Nethralaya, Chennai, and went on to pursue a research fellowship at the world renowned Wilmer eye institute, Johns Hopkins University School of Medicine, USA. He was awarded the Mc Cartney prize by the Royal College of Ophthalmologist's in London for securing the highest marks in Ocular Pathology in FRCOphth Part I exam held in January 2010 and had the distinction of being the first ever non-British national to receive this award. He was the recipient of Dr G. Venkataswamy Gold Medal in DNB Ophthalmology exam held in December 2009. He was awarded the best research fellow as well as the best outgoing fellow 2010 – 2012 at Sankara Nethralaya. He was awarded the “Young Achievers Award” by the Vidarbha Ophthalmic Society in 2015 for his outstanding achievements and contribution to ophthalmic research in India. He has published 90+ articles in peer-reviewed journals.
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Last accessed on 2021 Mar 07