Vascular endothelial growth factor (VEGF) inhibitors—approved agents Eylea (Regeneron) and Lucentis (Roche/Genentech), and off-label Avastin (Roche/Genentech)—are the treatment mainstays for diabetic macular edema (DME). Allergan’s Ozurdex and Alimera Sciences’ Iluvien, two long-acting corticosteroid implants, are also used to treat DME. The market heated up in April 2017 when the label of Lucentis 0.3 mg was expanded to treat patients with diabetic retinopathy (DR) without DME. Factoring in the anticipated approval of Eylea for nonproliferative DR patients without DME in the United States, as well as the expected availability of biosimilars of Lucentis 0.5 mg and Eylea and emerging therapies for DME, this report delivers actionable insights to help companies best position their DME/DR products to succeed in the U.S. access and reimbursement environment.

Questions Answered

  • Does coverage of therapies for DME differ on MCOs’ largest Medicare Advantage and commercial insurance plans? How do various cost-control measures impact prescribing of current therapies for DME?
  • How do pharmacoeconomic/health economic outcomes data impact formulary decision-making for drugs for DME?
  • Do physicians expect to prescribe the emerging therapies abicipar pegol (Allergan), Luminate (Allegro Ophthalmics), and RG-7716 (Roche) to their DME patients? What factors would influence preferred coverage of these agents on the MCOs’ largest risk-based commercial plans?
  • How is the expected availability of biosimilars of Lucentis 0.5 mg and Eylea likely to impact access to and reimbursement of the originator branded therapies for DME?

Product Description

Access & Reimbursement provides in-depth insight regarding the impact of payer policy on physician prescribing behavior so you can build your market access strategy and optimize your brand positioning.

Markets covered: United States

Primary research:

  • Survey of 104 ophthalmologists/retinal specialists in the United States.
  • Survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).

Key companies: Roche/Genentech, Regeneron, Alimera Sciences, Allergan, Allegro Ophthalmics

Key drugs: Avastin, Eylea, Lucentis, Iluvien, Ozurdex, RG-7716, Luminate, abicipar pegol

Content highlights:

  • Reimbursement and contracting.
  • Access and prescribing.
  • Special topics.
  • Opportunities and challenges for emerging therapies.

Table of contents

  • Diabetic Macular Edema / Diabetic Retinopathy - Access & Reimbursement - Detailed, Expanded Analysis (US)

Author(s): Himanshu Jain, M.S. Pharm

Himanshu joined the CNS / ophthalmology team at Decision Resources Group in 2016. He has authored content for psychiatry and ophthalmology (retinal / nonretinal) indications, including schizophrenia, age-related macular degeneration, diabetic retinopathy / diabetic macular edema, dry eye disease, glaucoma, and uveitis.

Himanshu has more than ten years of experience working in market research and consulting firms, and has managed multiple market assessment projects, including bottom-up forecasts, across multiple therapy areas. He holds a M.S. degree in Pharmacology and Toxicology from the National Institute of Pharmaceutical Education and Research in India and an Executive Post-Graduate Diploma in International Business from the Indian Institute of Foreign Trade.


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