Biosimilars in inflammatory bowel disease: Beyond evidence, toward trust and implementation

Figure 2 Multi-level barriers to biosimilar adoption in inflammatory bowel disease. This figure summarizes the interacting barriers to biosimilar implementation at the patient, physician, and system levels. Patient-level barriers include the nocebo effect, low health literacy, trust deficits, and social media misinformation. Physician-level barriers include knowledge gaps, cognitive bias, medicolegal concerns, risk aversion, and limited biosimilar experience. System-level barriers include mandatory switching policies without communication support, reimbursement structures focused on short-term savings, formulary constraints, and limited monitoring infrastructure. These barriers interact bidirectionally and may reinforce one another.