- Loss of copayment assistance for drugs to treat neovascular age-related macular degeneration forces patients onto alternative, potentially less effective treatment strategies.
- Patients who switched to bevacizumab required significantly more frequent injections to maintain visual outcomes.
- Depletion of funding for copayment support has increased out-of-pocket costs that disproportionately affect lower-income patients.
Loss of copayment assistance for drugs to treat neovascular age-related macular degeneration (nAMD) significantly disrupted patient care, including switching to less costly (and perhaps less effective) therapy, reliance on samples, and higher out-of-pocket costs, a small prospective study showed.
Involving 110 older patients seen by a Northern California retina practice, the study showed that three-fourths of the patients lost copayment support following depletion of the Good Days Chronic Disease Fund (CDF). About half of the patients who lost copayment support switched from their current medication to bevacizumab, three of whom switched back because of persistent fluid accumulation, becoming dependent on samples or paying more out of pocket.
Disruption of existing care did not adversely affect visual acuity or retinal anatomy during 6 months of follow-up, but patients with worse baseline visual acuity and those who required more frequent injections had less improvement in vision, reported Soraya Rofagha, MD, MPH, of East Bay Retina Consultants in Oakland, California, and colleagues in JAMA Ophthalmology.
“In our cohort, switching to bevacizumab was associated with short-term need for more frequent injections to maintain similar visual and structural outcomes, consistent with clinician survey findings,” the authors stated. “Our findings also suggest that higher-risk eyes may be placed at increased risk following switching due to funding loss.”
“The impact of these substantial expenses (on average, $1,139.89 out of pocket over 6 months) is likely to disproportionately affect patients with lower income or older patients on fixed incomes,” they added. “One patient who lost funding became dependent on samples. Prior studies have described increased reliance on unsustainable strategies following copayment assistance withdrawal, including sample use and continued off-label therapy despite suboptimal response. Certain institutions preclude sample use, further restricting access to on-label treatments.”
Nationwide Issue
Though limited by small numbers from a single retina practice, the results mirror those reported last year at the American Society of Retina Specialists (ASRS) meeting. The summary results from a survey of ASRS members showed that 61% of respondents had patients with vision loss associated with cost-related delays in treatment following depletion of the Good Days CDF. A similar proportion linked the funding depletion to patients lost to follow-up. Three-fourths of respondents said the loss of copayment support disproportionately affected lower-income patients and those from underserved communities.
Also at the ASRS meeting, an analysis of electronic health records for 280,000 treated eyes showed emergence of “unsustainable care patterns” and worse vision outcomes associated with switching to lower-cost therapy and reliance on samples of previously reimbursed medications.
“The underfunding of Good Days has caused widespread treatment disruptions for Medicare-aged patients with retinal diseases, particularly in low-income areas,” said Michael Lai, MD, PhD, of the Retina Group of Washington in Chevy Chase, Maryland, and a member of the ASRS Health Economics Committee, during a report to the ASRS membership. “Retina specialists report a growing dependence on less effective treatment alternatives, delays in care, complete discontinuation of therapy, and patient harm.”
“Copay assistance programs play a critical role in access to retinal therapy and preservation of vision,” he added. “There is an urgent need to restore adequate funding.”
In the year that has passed, a good news/bad news situation has evolved with respect to copayment assistance for nAMD drugs, Lai told MedPage Today. The good news is that Good Days and several other nonprofit organizations have received additional funding for copayment assistance.
“Unfortunately, the bad news is the funding has not been enough,” said Lai. “At the moment, the funding these organizations received has been depleted. What happens is that periodically, funds become available, and the [copayment assistance] opens up for re-enrollment. But the window for re-enrollment will be very short, because the funds get depleted so quickly. Sometimes the window closes within a few days or sometimes even within a few hours.”
“Many practices, including mine, have devoted resources in the form of staff to check the websites, in our case on a daily basis, so that when the funds become available we will have a long list of patients to sign up,” he added. “This adds to our overhead costs, because this is uncompensated work. Also, imagine the situation at smaller practices that are perhaps more strained for resources, practices that are already struggling with staffing and turnover.”
The vast majority of patients treated for nAMD are Medicare eligible. Standard Medicare covers 80% of the cost of the drugs, and patients must cover the remaining 20% unless they have supplemental coverage or other financial resources, said Lai. The situation with Medicare Advantage plans varies with each plan’s cost-sharing requirements.
Additional studies on the issue will be reported at the ASRS annual meeting next month in Montreal, said Lai. Those studies may shed additional light on the current status of copayment assistance programs, including at the level of individual practices.
A Single Practice’s Experience
Rofagha and colleagues reported findings from a retrospective review of records for patients treated for nAMD from June 2024 to June 2025. All patients had a treat-and-extend strategy per their individual physicians. Investigators grouped patients according to treatment strategy following loss of copayment funding: switch from existing medication to bevacizumab or remain on the same biologic class as a result of retained copayment assistance, use of samples, secondary insurance, or self-payment for the higher out-of-pocket cost.
The study population had a mean age of 85, and women accounted for two-thirds of the patients. The analysis included 139 treated eyes. The records showed that 82 patients lost copayment assistance, 50 of whom switched to bevacizumab. The remaining patients continued their existing biologic medication, 19 with secondary insurance, 13 who paid the additional out-of-pocket cost, and one who repeatedly used samples.
After 6 months of follow-up, comparison of patients who switched with those who did not showed no significant difference in median central subfield thickness (237 vs 225 µm, P=0.25) or best corrected visual acuity (0.4 logMAR in each group). However, patients who switched to bevacizumab required more frequent treatment (median treatment interval 7.0 vs 10.0 weeks, P<0.001), whereas treatment interval was similar in both groups at baseline.
About 200 patients in Rofagha’s group received CDF assistance prior to funding depletion. Currently, they have 110 patients receiving assistance and 22 on a waitlist. Her practice has a staff member who monitors the CDF several times a day.
“If we are lucky, we can get about five patients enrolled before it closes,” she told MedPage Today.
Good Days did not respond to a request for information about the status of the CDF. Regeneron, which markets aflibercept (Eylea), previously announced a $200 million donation matching fund for Good Days. A company spokesperson told MedPage Today the funding program is still active and noted that donations are not tied to use of any specific medication.
