Age-Related Macular Degeneration | Access & Reimbursement | US | 2022

The wet age-related macular degeneration (AMD) therapy market in the United States is unique given that the key approved therapies—Roche / Genentech’s Lucentis, Regeneron’s Eylea, Novartis’s Beovu, Roche’s Susvimo, and Roche’s Vabysmo—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 has increased with the launches of Roche’s Vabysmo and Susvimo and will grow further with the launches of Regeneron’s high-dose aflibercept, Kodiak Sciences’ KSI-301, and AbbVie / Regenxbio’s gene therapy RGX-314; these agents may offer a dosing advantage over the currently available VEGF inhibitors and thus address a substantial unmet need. In addition, biosimilar versions of Lucentis began launching in July 2022 and biosimilar versions of Eylea will follow the year after, 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 affect the prescribing of the approved wet AMD therapies Eylea, Lucentis, and 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?
  • What is the extent of Roche’s Vabysmo (faricimab) and Susvimo (Roche’s ranibizumab port delivery system) coverage on commercial and Medicare Advantage plans?
  • 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 on their commercial and Medicare Advantage plans?
  • How is the availability of biosimilars of Eylea and Lucentis likely to affect access to and reimbursement of the reference brands?

Content highlights

Geography: United States

Primary research: Survey of 99 U.S. ophthalmologists and 31 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs)

Key drugs covered: Avastin, Eylea, Lucentis, Beovu, Vabysmo, Susvimo, high-dose aflibercept, KSI-301, RGX-314

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.

Login to access report