While Genentech’s Lucentis continues to be the gold-standard treatment for wet age-related macular degeneration (AMD) in the United States, off-label use of Genentech’s Avastin (often compounded) captures the largest patient share owing to its very competitive pricing in this otherwise high-cost, yet price-sensitive, specialty pharmaceutical market. Meanwhile, Regeneron’s Eylea has seen strong uptake in the U.S. market since its launch in 2011 owing to a label for extended maintenance dosing frequency and a lack of monthly monitoring, highlighting the importance of dosing convenience to prescriber choice, regardless of brand pricing. The coming years may see the launch of several promising emerging therapies, including agents that offer novel mechanisms of action, greater convenience, or enhanced efficacy through adjunctive therapy. As the treatment landscape for wet AMD becomes increasingly complex, this report explores the market access opportunities and challenges that drug marketers face. We surveyed 100 retinal specialists to better understand the current wet AMD treatment algorithm and market access landscape from the physician perspective. In addition, 30 managed care organization (MCO) pharmacy and medical directors—whose MCO was required to offer Medicare Advantage in addition to commercial insurance—were queried to provide insight into factors influencing formulary inclusions/positioning for current therapies. Retinal specialists’ and payers’ receptivity to novel treatment options for wet AMD were also assessed to identify factors that will drive or constrain these agents’ uptake.

Questions Answered in This Report:

  • Treatment of wet AMD is dominated by three anti-vascular endothelial growth factor (VEGF) agents, off-label Avastin and the approved agents Eylea and Lucentis. What factors drive retinal specialists to prescribe Avastin, Eylea, and Lucentis? What reasons are identified for prescribing one anti-VEGF agent rather than the alternatives? How do market access hurdles differentially impact retinal specialists’ prescribing of each agent for patients with commercial insurance versus Medicare?

  • Wet AMD represents a high-cost market where price sensitivity may influence prescribing decisions. For commercial and Medicare Advantage plans, what are the current formulary placement and tier assignment of agents used to treat wet AMD? What type of cost controls do MCOs impose on current wet AMD therapies? To what extent are copayments and coinsurance charges levied on anti-VEGF agents?

  • Multiple products are in development for wet AMD that may offer distinct clinical advantages compared with current anti-VEGF agents. What drug development achievements in wet AMD (e.g., patient-delivered formulations, longer-acting formulations, superior efficacy) will be most valued by physicians and payers? How do physicians and payers anticipate integrating key emerging agents into the wet AMD treatment algorithm and onto their formularies, respectively?


Markets covered: United States.

Primary research: 100 country-specific interviews with retinal specialists; 20 MCO pharmacy directors, 10 MCO medical directors.

Epidemiology: 2013, 2018, and 2023 diagnosed prevalent cases of wet AMD.

Emerging therapies: Phase II: 3 drugs; Phase III: 1 drug.

Author(s): Emma McFadden