Dry and Wet Age-Related Macular Degeneration – Access & Reimbursement – Access & Reimbursement – Age-Related Macular Degeneration (US)
The age-related macular degeneration (AMD) therapy market in the United States is unique because the market penetration of approved branded therapies—Roche / Genentech’s Lucentis, Regeneron’s Eylea and Eylea HD, Novartis’s Beovu, and Roche’s Vabysmo—and of ranibizumab biosimilars has been hampered by the availability of Roche’s Avastin (bevacizumab), frequently compounded and prescribed off-label because of its lower price. Competition facing key brands will further intensify with the launch of Optea’s sozinibercept and the potential launch of AbbVie / Regenxbio’s gene therapy ABBV-RGX-314, as well as biosimilars of Eylea that are expected to launch in the near future. In contrast, the market for geographic atrophy (GA) is limited to two therapies that launched in the United States in 2023—Apellis’s Syfovre and Astellas’s Izervay—although the GA pipeline is quite active. This report will help marketers explore how biosimilars could impact access to premium-priced wet AMD brands and how the introduction of the first gene therapy with an anticipated high price may affect the market and understand the market access challenges in the new GA market.
QUESTIONS ANSWERED
- Does coverage of the key VEGF inhibitors for wet AMD differ on MCOs’ largest Medicare Advantage and commercial insurance plans? To what extent do payers’ cost-control measures impact prescribing of these approved therapies and of Avastin?
- How has the availability of biosimilars of Lucentis impacted the brand, and how will the availability of biosimilars of Eylea impact access to and reimbursement of its reference brand? What impact might they have on recently launched therapies such as Vabysmo and Eylea HD?
- How do U.S. ophthalmologists use Syfovre and Izervay to treat GA secondary to AMD? How do MCOs cover these agents?
- Do ophthalmologists expect to prescribe therapies in late-phase development to their Medicare and commercially insured wet AMD patients? How do payers expect to cover these therapies, and how will those decisions affect prescribing?
CONTENT HIGHLIGHTS
Geography: United States
Primary research: Survey of 100 U.S. ophthalmologists; survey of 30 U.S. MCO PDs / MDs
Fingertip formulary: Formulary coverage and restrictions data for wet AMD therapies and Syfovre by commercial plans covering approximately 160.8 million lives and Medicare Part D plans covering 26.0 million lives nationally.
Key drugs covered: Eylea, Lucentis, Beovu, Vabysmo, Susvimo, Avastin, Byooviz, Cimerli, Eylea HD, ABBV-RGX-314, sozinibercept, Syfovre, Izervay
Content highlights:
Reimbursement and contracting.
Access and prescribing.
Opportunities and challenges for emerging therapies.
Disease-specific special topic: the impact of aflibercept biosimilars on the wet AMD therapy market
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.
