Ophthalmology · 2026
Access to Intravitreal Anti-VEGF Drugs in Persons with Medicare Advantage Compared with Medicare Fee-For-Service Coverage.
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Chan Jennifer, Repka Michael X, Williams George A, Vail Daniel, Lum Flora, Begaj Tedi, Friedman Scott, Parikh Ravi
Аннотация
PURPOSE: To investigate intravitreal anti-VEGF drug use among Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) beneficiaries.
DESIGN: Retrospective, cross-sectional analysis of de-identified health care data from the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight) for patient encounters between January 2017 and December 2022.
PARTICIPANTS: Medicare beneficiaries 65 years of age and older with FFS or MA coverage with continuous insurance enrollment for at least 12 months.
METHODS: Unique FFS and MA beneficiaries receiving intravitreal anti-VEGF therapy were included. Patients were considered to be treated with a particular drug if more than 50% of the injections for at least 12 months were with that drug. For each anti-VEGF drug, we compared proportions of patients treated (> 50% of the injections) with that drug between FFS and MA groups and calculated the difference in use between the 2 Medicare health care programs.
MAIN OUTCOME MEASURES: Differences in anti-VEGF drug use between FFS and MA groups.
RESULTS: Nine hundred thirty thousand four hundred and eleven beneficiaries underwent 12 942 057 intravitreal injections. In the FFS group, aflibercept 2 mg was used most frequently (43.8%; n = 4 271 050), followed by bevacizumab (34.7%; n = 3 382 439), ranibizumab (20.6%; n = 2 008 791), brolucizumab (0.6%; n = 56 728), and faricimab (0.4%; n = 40 729). In the MA group, bevacizumab was used most frequently (45.1%; n = 1 436 151), followed by aflibercept 2 mg (37.8%; n = 1 201 311), ranibizumab (16.5%; n = 524 758), brolucizumab (0.4%; n = 13 406), and faricimab (0.2%; n = 6694). Repackaged bevacizumab (lower cost) was more common in the MA group compared with the FFS group (60.0% vs. 47.0%; difference, 13.0%; 95% confidence interval [CI], 12.8%-13.3%; P < 0.001). Higher-cost drugs were used significantly less often among those with MA compared with FFS coverage, respectively (aflibercept 2 mg, 28.9% vs. 36.6%; difference, -7.7%; 95% CI, -7.9% to -7.4%; P < 0.001), ranibizumab (11.9% vs. 16.8%; difference, -4.9%; 95% CI, -5.0% to -4.7%; P < 0.001), faricimab (0.06% vs. 0.24%; difference, -0.1%; 95% CI, -0.19% to -0.16%); P < 0.001), and brolucizumab (0.12% vs. 0.19%; difference, -0.01%; 95% CI, -0.09% to -0.05%; P < 0.001).
CONCLUSIONS: Beneficiaries enrolled in MA were less likely to receive higher-cost anti-VEGF drugs, raising concerns about reduced beneficiary access to newer, more expensive anti-VEGF drugs among those with MA coverage.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Retrospective, cross-sectional analysis of de-identified health care data from the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight) for patient encounters between January 2017 and December 2022.
PARTICIPANTS: Medicare beneficiaries 65 years of age and older with FFS or MA coverage with continuous insurance enrollment for at least 12 months.
METHODS: Unique FFS and MA beneficiaries receiving intravitreal anti-VEGF therapy were included. Patients were considered to be treated with a particular drug if more than 50% of the injections for at least 12 months were with that drug. For each anti-VEGF drug, we compared proportions of patients treated (> 50% of the injections) with that drug between FFS and MA groups and calculated the difference in use between the 2 Medicare health care programs.
MAIN OUTCOME MEASURES: Differences in anti-VEGF drug use between FFS and MA groups.
RESULTS: Nine hundred thirty thousand four hundred and eleven beneficiaries underwent 12 942 057 intravitreal injections. In the FFS group, aflibercept 2 mg was used most frequently (43.8%; n = 4 271 050), followed by bevacizumab (34.7%; n = 3 382 439), ranibizumab (20.6%; n = 2 008 791), brolucizumab (0.6%; n = 56 728), and faricimab (0.4%; n = 40 729). In the MA group, bevacizumab was used most frequently (45.1%; n = 1 436 151), followed by aflibercept 2 mg (37.8%; n = 1 201 311), ranibizumab (16.5%; n = 524 758), brolucizumab (0.4%; n = 13 406), and faricimab (0.2%; n = 6694). Repackaged bevacizumab (lower cost) was more common in the MA group compared with the FFS group (60.0% vs. 47.0%; difference, 13.0%; 95% confidence interval [CI], 12.8%-13.3%; P < 0.001). Higher-cost drugs were used significantly less often among those with MA compared with FFS coverage, respectively (aflibercept 2 mg, 28.9% vs. 36.6%; difference, -7.7%; 95% CI, -7.9% to -7.4%; P < 0.001), ranibizumab (11.9% vs. 16.8%; difference, -4.9%; 95% CI, -5.0% to -4.7%; P < 0.001), faricimab (0.06% vs. 0.24%; difference, -0.1%; 95% CI, -0.19% to -0.16%); P < 0.001), and brolucizumab (0.12% vs. 0.19%; difference, -0.01%; 95% CI, -0.09% to -0.05%; P < 0.001).
CONCLUSIONS: Beneficiaries enrolled in MA were less likely to receive higher-cost anti-VEGF drugs, raising concerns about reduced beneficiary access to newer, more expensive anti-VEGF drugs among those with MA coverage.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.