Age-Related Macular Degeneration | Access & Reimbursement | US | 2021

The wet age-related macular degeneration (AMD) market in the United States is unique given that the key approved therapies—Roche / Genentech’s Lucentis, Regeneron’s Eylea, and Novartis’s Beovu—face competition from low-priced off-label Avastin (Roche / Genentech). The approved premium-priced therapies place a substantial burden on payers; therefore, despite being effective and safe, they are subject to payer restrictions. Competition is expected to increase with the launches of Roche’s faricimab, Roche’s ranibizumab port delivery system, Regeneron’s high-dose aflibercept, Kodiak Sciences’ KSI-301, and Regenxbio’s RGX-314; these agents potentially offer a dosing advantage over the currently available VEGF inhibitors and address a substantial unmet in this market. Biosimilar versions of Eylea and Lucentis are also anticipated to launch soon, making it essential to understand how these therapies could impact access to premium-priced brands.

QUESTIONS ANSWERED

• Does coverage of the key VEGF inhibitors for wet AMD differ on MCOs’ largest Medicare Advantage and commercial insurance plans?
• How do various cost-control measures impact prescribing of approved wet AMD therapies Eylea, Lucentis, Beovu, and off-label Avastin? How are biosimilar versions of bevacizumab (Amgen’s Mvasi and Pfizer’s Zirabev) reimbursed or prescribed for wet AMD, if at all?
• Do ophthalmologists expect to prescribe late-phase emerging therapies to their Medicare and commercially insured wet AMD patients? How do payers expect to cover these therapies on their commercial and Medicare Advantage plans?
• How is the expected availability of biosimilars to Eylea and Lucentis likely to impact access to and reimbursement of their reference brands?

GEOGRAPHY: United States

PRIMARY RESEARCH: Survey of 100 U.S. ophthalmologists; survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs)

KEY DRUGS COVERED: Avastin, Eylea, Lucentis, Beovu, faricimab, ranibizumab port delivery system, high-dose aflibercept, KSI-301, RGX-314

CONTENT HIGHLIGHTS: Reimbursement and contracting, access and prescribing, opportunities and challenges for emerging therapies, potential coverage and use of biosimilar anti-VEGF products

PRODUCT DESCRIPTION

U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.