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

Document Type

Article

Publication Date

6-29-2026

Publication Title

Ophthalmology

Abstract

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

DESIGN: 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.

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

METHODS: 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.

MAIN OUTCOME MEASURES: Differences in anti-VEGF drug utilization between FFS and MA.

RESULTS: 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).

CONCLUSIONS: 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.

Volume

S0161-6420

Issue

26

First Page

00453-7

DOI

10.1016/j.ophtha.2026.06.019

ISSN

1549-4713

PubMed ID

42372829

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