Pulse ·

IBD in Australia: the biologic medicines most can't access

By Dr HB Lo, FACRRM 4 min read
Verdict Yes — worth knowing about

Australia reimburses fewer new medicines through the PBS than comparable countries. For people living with inflammatory bowel disease — Crohn's disease or ulcerative colitis — this means newer biologic agents with better safety and efficacy data are often out of reach without high out-of-pocket cost.

A Medicines Australia report found only 25% of innovative medicines launched globally over the past decade received PBS reimbursement in Australia, compared with 46% in the UK and 88% in the US. Eighteen IBD medicines have been delayed or abandoned for the Australian market entirely. For patients who have stopped responding to available agents, the options narrow quickly.

What just happened

A newly released industry report has put a number on something gastroenterologists and their patients already know: Australia’s pharmaceutical reimbursement system is leaving people with inflammatory bowel disease without access to the medicines they need.

The Medicines Australia Bitter Pill report makes the shortfall concrete. Only 25% of innovative medicines launched globally over the past decade received PBS reimbursement in Australia — compared with 46% in the UK and 88% in the United States. Eighteen medicines relevant to IBD have been delayed or never pursued here at all.

For the approximately 180,000 Australians living with Crohn’s disease or ulcerative colitis, this is not an abstract policy issue. It means that when a biologic you’re on stops working — and loss of response is common in IBD, not an edge case — the next agent your gastroenterologist would most like to offer may not be accessible through Medicare or the PBS. The options are to try an older, less effective drug, pay several thousand dollars a month out of pocket, or wait.

Waiting, in IBD, has consequences. Uncontrolled inflammation means more hospitalisations, a higher chance of surgery, and for women of reproductive age, risks to fertility and ongoing quality of life that compound over years. Most IBD diagnoses happen in a person’s twenties or thirties. The gap in treatment access is not experienced once — it is managed over a lifetime.

Both-and

The access gap is real and verifiable

The medicines most affected by Australia’s PBS framework in IBD right now are the newer IL-23 inhibitors — agents that have demonstrated better safety profiles and more durable responses in head-to-head trials against older biologics. These are not experimental therapies. They are available in comparable health systems. What they don’t do is meet Australia’s cost-effectiveness thresholds under a framework that prices new agents against cheaper existing alternatives, making it commercially non-viable for manufacturers to pursue PBS listing at prices they can sustain.

Associate Professor Réme Mountifield, a gastroenterologist at Flinders Medical Centre, described the clinical reality plainly: “We can’t see a patient at diagnosis and say this drug is perfect for you. It’s often an educated guess amongst the advanced therapies.” That guess gets harder when the list of available agents is truncated by reimbursement gaps.

Evidence supports aggressive early intervention — within the first three months of a significant flare — before irreversible damage to the bowel wall accumulates. When patients cycle through available agents waiting for one that works, that early treatment window closes.

The PBS exists for real reasons

The cost-effectiveness threshold that drives PBS listing decisions is not arbitrary. It exists to prevent Australian health spending from being captured by manufacturers pricing for high-income, commercially dominant markets. It has protected Australians from some of the per-medication costs that have made healthcare unaffordable for many people in the United States.

The Medicines Australia Bitter Pill report is also an industry document. It is authored by pharmaceutical manufacturers with a direct commercial interest in loosening access restrictions — every relaxation of cost-effectiveness thresholds benefits their revenue line. That does not make the data wrong. The reimbursement gap it describes is real and verifiable. But the call for reform comes from a party with a stake in the outcome, and that is worth naming plainly.

Spending more on newer biologics means spending less on something else within the same health budget — or raising the overall allocation. Australia’s general practice system is chronically under-resourced. Specialist waiting times are at record lengths. These are competing priorities within the same fiscal envelope, and a report from the pharmaceutical industry does not dissolve that tension.

My two cents

If you are living with Crohn’s or ulcerative colitis and your current treatment is not adequately controlling your symptoms, the most useful conversation you can have this week is with your gastroenterologist — or with your GP about a referral if you have not seen a specialist recently.

Ask specifically: which agents exist that aren’t currently listed on the PBS, what does accessing them look like, and is there a clinical trial that might be relevant to your situation? Some pharmaceutical companies run compassionate access programmes during the period before a PBS listing is finalised — your gastroenterologist will know which are currently available.

The Bitter Pill report will filter into parliamentary discussion on medicines access. The shape of any policy response will partly depend on whether patients and clinicians make their experience visible in that process. Patient advocacy organisations track PBS listing timelines and can advise on how to engage — if this affects you or someone you care for, that is a pathway worth knowing about.

Verdict: yes — this gap is real, consequential, and worth understanding whether you are managing IBD or supporting someone who is.

Sources cited

  1. IBD patients caught in Australia’s medicines access gap. Medical Republic, 6 August 2026. https://www.medicalrepublic.com.au/ibd-patients-caught-in-australias-medicines-access-gap/127978
  2. Bitter Pill: The case for medicines access reform in Australia. Medicines Australia, July 2026. https://www.medicinesaustralia.com.au/wp-content/uploads/sites/65/2026/07/03826-MA-BitterPill-Report_Accessible_Final.pdf
  3. Pharmaceutical Benefits Scheme (PBS). Australian Government Department of Health. https://www.pbs.gov.au

Frequently asked questions

  • What are biologic medicines and why do they matter in IBD?

    Biologic medicines are drugs derived from living cells that target specific proteins involved in inflammation. Different classes block different parts of the immune cascade. In inflammatory bowel disease the ability to switch between biologic classes matters because many patients develop loss of response to one agent over time. When newer, more selective agents are unavailable through the PBS, clinicians must cycle through older options even when they have stopped working effectively.

  • What can I do if my IBD medicines aren't controlling my symptoms?

    The clearest first step is a conversation with a gastroenterologist — or a referral from your GP if you haven't seen one recently. Gastroenterologists can advise on which agents exist outside PBS listing, whether compassionate access programmes apply in your situation, and whether a clinical trial is relevant. Earlier escalation of therapy — within the first three months of a significant flare — is associated with better long-term outcomes in IBD.