Anti-VEGF Agents: How Does Cost Versus Dosing Impact the Wet AMD Treatment Algorithm Among Retinal Specialists in the United States? | Physician & Payer Forum | US | 2014

While Genentech’s Lucentis continues to be the gold-standard treatment for wet age-related macular degeneration (AMD) in the United States, off-label use of Genentech’s Avastin (often compounded) captures the largest patient share owing to its very competitive pricing in this otherwise high-cost, yet price-sensitive, specialty pharmaceutical market. Meanwhile, Regeneron’s Eylea has seen strong uptake in the U.S. market since its launch in 2011 owing to a label for extended maintenance dosing frequency and a lack of monthly monitoring, highlighting the importance of dosing convenience to prescriber choice, regardless of brand pricing. The coming years may see the launch of several promising emerging therapies, including agents that offer novel mechanisms of action, greater convenience, or enhanced efficacy through adjunctive therapy. As the treatment landscape for wet AMD becomes increasingly complex, this report explores the market access opportunities and challenges that drug marketers face. We surveyed 100 retinal specialists to better understand the current wet AMD treatment algorithm and market access landscape from the physician perspective. In addition, 30 managed care organization (MCO) pharmacy and medical directors—whose MCO was required to offer Medicare Advantage in addition to commercial insurance—were queried to provide insight into factors influencing formulary inclusions/positioning for current therapies. Retinal specialists’ and payers’ receptivity to novel treatment options for wet AMD were also assessed to identify factors that will drive or constrain these agents’ uptake.