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

To investigate intravitreal anti-VEGF drug use among Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) beneficiaries.

Retrospective, cross-sectional analysis of de-identified healthcare data from the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight) for patient encounters between January 2017 to December 2022.

Medicare beneficiaries 65 years and older with FFS or MA coverage with continuous insurance enrollment for at least12 months.

Unique FFS and MA beneficiaries receiving intravitreal anti-VEGF were included. Patients were considered to be treated with a particular drug if more than 50% of their injections for at least 12 months were with that drug. For each anti-VEGF drug, we compared proportions of patients treated (more than 50% of their injections) with that drug between FFS and MA and calculated the difference in use between the two Medicare health care programs.

Differences in anti-VEGF drug utilization between FFS and MA.

930,411 beneficiaries underwent 12,942,057 intravitreal injections. In the FFS group, aflibercept 2mg 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 2mg (37.8%; n = 1,201,311), ranibizumab (6.5%; n = 524,758), brolucizumab (0.4%; n = 13,406), and faricimab (0.2%; n = 6,694). Repackaged bevacizumab (lower cost) was more common in the MA group compared with the FFS group (60.0% vs. 47.0%; difference (diff) = 13.0%, 95% CI:12.8, 13.3%; P<.001). Higher cost drugs were used significantly less often among persons with MA compared with FFS, respectively (aflibercept 2mg (28.9 vs. 36.6%; diff = -7.7%; 95% CI -7.9%, -7.4%; P<.001), ranibizumab (11.9% vs. 16.8%; diff = -4.9%; 95% CI -5.03%, -4.7%; P<.001), faricimab (0.06% vs. 0.24%; diff = -0.18%; 95% CI -0.19%, -0.16%); P<.001, and brolucizumab (0.12% vs. 0.19%; diff = -0.07%; 95% CI -0.09%, -0.05%; P<.001).

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 in MA.