Utilization patterns of intravitreal corticosteroids in the Medicare population (2013-2022)

To evaluate national trends in intravitreal corticosteroid utilization among Medicare beneficiaries from 2013 to 2022, focusing on services billed, beneficiaries treated, and reimbursements.

A retrospective population-based analysis.

Medicare Part B beneficiaries receiving intravitreal corticosteroid injections.

Medicare Provider Utilization and Payment Data (2013-2022) were analyzed for intravitreal triamcinolone acetonide (TA; J3300) and dexamethasone implants (DEX; J7312). Each billed service represents a drug unit (1 mg TA; 0.1 mg DEX, with one 0.7 mg implant equaling seven units) rather than a discrete injection, so beneficiaries treated served as the primary, dose-independent metric. Temporal trends were assessed using the Mann-Kendall test, with linear regression used as a sensitivity analysis.

TA was billed by 753 providers (104,522 beneficiaries) and DEX by 1057 providers (187,929 beneficiaries). Because TA and DEX services measure milligrams rather than injection events, they are not directly comparable. TA beneficiaries declined 88% (p = .002), with the steepest drop in 2019-2020, paralleling an 89% fall in TA milligrams billed (p = .002). DEX billed units rose 275% (p = .02). DEX beneficiaries increased 188% overall but did not reach Mann-Kendall significance (p = .07) because the trend was nonmonotonic, plateauing after 2018; linear regression confirmed a significant increase (p = .02). Standardized drug-supply reimbursement was $1,093.33 per DEX implant versus $3.29-$13.16 per TA injection.

TA utilization declined substantially while DEX billing increased, likely reflecting differences in efficacy, safety, durability, cost, and availability, including TRIESCENCE supply limitations.