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

The prevalence of age-related macular degeneration (AMD) is increasing with the aging population in China. Therapies targeting vascular endothelial growth factor (VEGF) are fairly successful in delaying the disease progression of wet AMD, a leading cause of blindness. Notable agents include Lucentis (Novartis’s ranibizumab), newly launched and locally manufactured Langmu (Chengdu Kanghong’s conbercept), and compounded Avastin (Roche’s bevacizumab), which is used off-label but is far less expensive than other agents in the class. However, none of the premium-priced anti-VEGF agents is included on the national or provincial drug formularies. To maximize opportunity in the Chinese market, developers of emerging therapies must carefully balance preferred pricing with uptake potential, especially when taking into account the availability of Avastin and local product Langmu, as well as the anticipated emergence of anti-VEGF biosimilars.

Questions Answered in This Report:

  • Explore current and evolving prescribing trends: How do prescribing patterns differ between anti-VEGF agents for wet AMD? How does drug reimbursement status influence prescribing? What clinical attributes are most influential to physicians when selecting treatments for wet AMD, and how does the interplay between dosing regimen and cost factor into prescribing decisions? How has the availability of locallydeveloped Langmu impacted prescribing patterns in wet AMD? How are physicians using off-label compounded Avastin compared with on-label Lucentis? How do differences in prescribers’ perceptions of major brands versus biosimilars impact prescribing? How will the use of currently marketed agents evolve over the next three years?

  • Assess payer attitudes toward approved anti-VEGF agents for wet AMD: Which agents are included on the National Reimbursement Drug List (NRDL) or Provincial Reimbursement Drug Lists (PRDLs)? What are the restrictions for the reimbursement of formulary-listed drugs? How might reimbursement of key wet AMD therapies change in the near future? What therapies do payers expect to be included in the new NRDL and/or PRDLs? How might the new “free pricing” policy and “public hospital reform” in China affect the pricing and reimbursement of wet AMD therapies? How are the upcoming biosimilars perceived by payers? Will the presence of biosimilars drive a price cut on the branded products and have an impact on the reimbursement status of anti-VEGF agents?

  • Explore the outlook for emerging agents: What are the greatest unmet needs in wet AMD treatment? How are the emerging drugs Eylea and Ozurdex perceived? How do physicians expect to prescribe them? What are payers’ expectations for access to emerging therapies? How will payer policy impact their uptake? How will market access barriers evolve and what challenges are companies likely to face in the future? How do ophthalmologists expect to prescribe biosimilars?


This Emerging Physician & Payer Forum report surveys 50 ophthalmologists and interviews three payers in China. We explore the national and regional market access factors that will impact the treatment of wet AMD in China in the next 2-3 years.

Markets covered: China.

Primary research:

50 ophthalmologists completed an online quantitative survey designed by therapeutic and country experts.

Three payers/payer-advising thought leaders who have influence on reimbursement of wet AMD drugs at a national or regional level were interviewed.

- Member, Ministry of Human Resources and Social Security (MOHRSS) for updating of the PRDL, Guangdong.

- Member, Ministry of Human Resources and Social Security (MOHRSS) for updating of the PRDL, Jiangsu.

- Member, China Food and Drug Administration (CFDA) for new drug application review, Beijing.

Author(s): Michelle Zhou, M.B.B.S., Ph.D.

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