Dry and Wet Age-Related Macular Degeneration – Access & Reimbursement – Access & Reimbursement – Age-Related Macular Degeneration (US)
The U.S. wet AMD market is led by intravitreal therapies such as Eylea, Eylea HD, and Vabysmo, alongside the continued off-label use of compounded Avastin, driven by cost considerations. In addition, the launch of Pavblu, a biosimilar of Eylea, adds further competitive pressure to established brands. Payer utilization management strategies remain key influencers of prescribing. The anticipated launch of TKIs (e.g., EyePoint’s Duravyu, Ocular Therapeutix’s Axpaxli) and particularly gene therapies (i.e., AbbVie / Regenxbio’s sura-vec, Adverum / Eli Lilly’s ixo-vec, and 4DMT’s 4D-150), which aim to reduce dosing frequency compared with current options, raises questions about coverage and affordability. In parallel, the geographic atrophy (GA) market is evolving following the introduction of Apellis / Biogen’s Syfovre and Astellas’s Izervay in 2023. Understanding how MCOs approach formulary placement and access for both wet AMD and GA treatments will be critical for stakeholders navigating this competitive market.
QUESTIONS ANSWERED
- How do payer policies and formulary restrictions affect access to AMD therapies in the United States?
- What cost-control measures are most commonly applied to branded AMD treatments?
- How does the availability of biosimilars influence coverage and reimbursement for reference brands?
- What are payers’ perspectives on high-cost emerging therapies?
- How do access dynamics affect ophthalmologists’ prescribing decisions across patient segments?
CONTENT HIGHLIGHTS
Geography: United States
Primary research: Survey of 100 U.S. ophthalmologists; survey of 30 U.S. MCO PDs / MDs, and two interviews of MDs at national MCOs.
Fingertip formulary: Formulary coverage and restrictions data for wet AMD and GA therapies by plans covering approximately 20.4 million lives in U.S. commercial plans sponsored by MCOs.
Key drugs covered: Avastin, Eylea, Pavblu, Lucentis, Byooviz, Cimerli, Nufymco, Beovu, Susvimo, Vabysmo, Eylea HD, sura-vec (ABBV-RGX-314), Ixo-vec, Duravyu, Axpaxli, Syfovre, and Izervay.
Content highlights:
Reimbursement and contracting.
Access and prescribing.
Opportunities and challenges for emerging therapies.
Disease-specific special topic: treatment for geographic atrophy.
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.
