How Does Cost Versus Dosing Impact Prescriber Preferences and Payer Policy?

Agents that target vascular endothelial growth factor (VEGF) have expanded the treatment armamentarium in Brazil and Mexico for wet age-related macular degeneration (AMD), a leading cause of visual impairment and blindness. Notable anti-VEGF agents include Lucentis (Novartis) and Eylia/Wetlia (Bayer HealthCare), both of which are labeled for wet AMD, and compounded Avastin (Roche), a less-expensive off-label alternative. Maximized uptake of premium-priced anti-VEGF drugs—and, indeed, of any novel emerging wet AMD drug—will greatly depend on securing formulary coverage across healthcare programs in Brazil and Mexico. Yet, given Avastin’s availability and the anticipated emergence of discounted anti-VEGF biosimilars, drug developers will need to underscore the value of their products to payers in these cost-conscious Latin American markets.

Questions Answered in This Report:

  • Assess physician and payer attitudes toward wet AMD therapies and determine the current market access environment for anti-VEGF agents in Brazil and Mexico: How does access to wet AMD therapies actually take place, in public and private settings? How does it vary between countries? What are the current drivers and barriers to prescribing each of the anti-VEGF agents for wet AMD, and what are the main cost-related/clinical constraints to these agents’ uptake? Which anti-VEGF drugs are included in formularies of government-sponsored and/or social security programs in Brazil and Mexico? How do coverage/reimbursement status and resulting restrictions affect on-label and off-label prescribing of wet AMD therapies? What clinical attributes are most influential to physicians when selecting treatments for wet AMD, and how does the interplay between dosing regimen and price factor into prescribing decisions? How do surveyed oncologists anticipate the prescribing of wet AMD therapies will evolve by 2019?

  • Explore the outlook for emerging agents and biosimilars: What clinical and commercial factors will most likely convince payers to grant emerging agents coverage and advanced positioning? What is the impact of HTAs and pricing negotiations on coverage of, and access to, new market entrants in each country? What role will head-to-head and pharmacoeconomic outcomes play in differentiating the reimbursement of new therapies versus current mainstays? How do payers expect access to costly anti-VEGF drugs to evolve through 2019, and to what extent will payers and ophthalmologists embrace key late-stage emerging brands, combination regimens, and anti-VEGF biosimilars?


This Emerging Markets Physician & Payer Forum report entitled “Current and Future Uptake of Anti-VEGF Agents for Wet AMD in Brazil and Mexico: How Does Cost vs. Dosing Impact Prescriber Preferences and Payer Policy?” surveys 101 ophthalmologists and interviews 6 payers in Brazil and Mexico to explore how both parties shape the prescribing and access environment for current wet AMD therapies and to assess how the wet AMD market will evolve in the next four years as treatment options expand and pricing and reimbursement processes within these two countries evolve.

Markets covered: Brazil and Mexico.

Primary research: This report draws on insights from 101 surveyed ophthalmologists and 6 interviewed payers. Interviewees were required to be influential in determining patient access to ophthalmology drugs used in the treatment of wet AMD at the institutional or regional/national level and came from the following backgrounds:

- Brazil: Director of the division of pharmacy at the Hospital das Clinicas, University of São Paulo, a reference hospital to the State of Sao Paulo and the MoH, and member of the hospital’s Pharmacy & Therapeutics committee; ophthalmologist/retina specialist in the College of Medicine of ABC and member of the Medicine Standardization Commission of the institution; owner of a private clinic; ophthalmologist, member of the drug standardization committee, and auditor of high-cost drugs for a major Brazilian HMO.

- Mexico: Chief of the ophthalmology department of Hospital General de Zacatecas from ISSSTE; ophthalmologist responsible for the retina service in the Centro Médico Nacional la Raza of IMSS; chief of ophthalmology at the Hospital Juárez de México of the Secretaria de Salud; managers of access to wet AMD drugs and providers of technical opinions on new treatments; active members of the Mexican Retina Association, Mexican Society of Ophthalmology, Mexican Council of Ophthalmology, EURETINA, and PAAO.

Author(s): Laurie DiModica, M.S.

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