Access to Intravitreal Anti-VEGF Drugs in Persons with Medicare Advantage Compared with Medicare Fee-For-Service Coverage.

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.