Abstract
Purpose :
Anti-vascular endothelial growth factor (VEGF) agents have been widely adopted to treat a growing number of ocular diseases. Step therapy was implemented in 2019 as a fail-first approach adopted by health plans requiring failure of bevacizumab prior to switching to other agents. This policy has had uncertain implications on practitioner use patterns and supply chain considerations. Although the rate of growth of intravitreal anti-VEGF agents use has been studied, the effects of step therapy on trends in medication use has not been well-elucidated.
Methods :
Intravitreal anti-VEGF injection data from 2018 through 2020 were gathered from the publicly available Medicare Physician & Other Practitioners - by Provider and Service database. Medication data was identified using Current Procedural Terminology (CPT) codes specifically for aflibercept, ranibizumab, and bevacizumab, and did not include other agents. High-volume injectors were defined as those within the top 10% by volume in 2020. For the purposes of time-based comparisons, statistical analysis was limited to ophthalmologists who administered at least one injection of bevacizumab, ranibizumab, and aflibercept.
Results :
Our primary outcome measures were nation-wide injection volume by medication and changes in injection volume for individual ophthalmologists. From 2018 through 2020, there were 9,731,861 injections attributed to 3,889 ophthalmologists (Table 1). Total injection volume was stable during this time. Aflibercept increased in relative usage by 21.2%, while bevacizumab’s relative usage increased by 1.66% and ranibizumab’s relative usage decreased by 25.1%.
All high-volume subgroups increased in their aflibercept injection volume (p<0.0001 for all groups) and decreased in their bevacizumab injection volume (p<0.05 for all groups) (Table 2). High-volume aflibercept injectors accounted for a lower percentage of national aflibercept injections (32.9% in 2020) compared to high-volume ranibizumab injectors (43.6% of national ranibizumab volume in 2020) and high-volume bevacizumab injectors (42.7% of national bevacizumab volume). These trends were consistent throughout the study period.
Conclusions :
Aflibercept usage rates have continued to rise, matched by a similar decline in ranibizumab usage. Interestingly, step therapy policies have not significantly changed bevacizumab usage on an aggregate level.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.