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.
- 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
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.
- Dry And Wet Age-Related Macular Degeneration - Access & Reimbursement - Detailed, Expanded Analysis (US)
- Access and Reimbursement Dry and Wet AMD US June 2021
Natalie Taylor, Ph.D.
Natalie Taylor, Ph.D., is a principal business insights analyst on the CNS/Ophthalmology Disorders team at Clarivate. She has more than ten years of experience authoring primary and market research reports for pharmaceutical industry clients in the fields of psychiatry, pain, neurology, and ophthalmology. Previously, Dr. Taylor worked at QuintilesIMS as manager of its CNS portfolio. She completed her Ph.D. in physiology at Dartmouth College in New Hampshire, where she studied the role of serotonergic neurons in the medullary raphe on modulating respiratory responses in mammals. She holds a B.S. in biology from Dickinson College in Pennsylvania.
Chris Lewis is a primary research manager at Clarivate. She is responsible for the coordination, content review, and content generation of U.S. Access & Reimbursement reports, including authoring select A&R reports on managed care trends. Before this position, Ms. Lewis was a senior analyst at HealthLeaders-InterStudy. She analyzed the managed care markets in California, New York, and Pennsylvania. She also launched and authored the Pharmacy Benefit Manager profile series. She received her bachelor’s degree from California State University in Sacramento.