Access to Anti-VEGF Therapeutics in Medicare Advantage Compared to Medicare Fee-For-Service

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : To investigate the patterns of access to intravitreal anti-VEGF therapies for Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) beneficiaries.

Methods : We conducted a retrospective, cross-sectional analysis of de-identified healthcare data from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) from January 2017 to December 2022. We included patients aged 65 and older with Medicare FFS or MA coverage when they received intravitreal anti-VEGF therapy, excluding individuals documented with more than one insurance type. For each anti-VEGF agent, we compared the proportion of majority users between Medicare FFS and MA and calculated the differences with 95% confidence intervals (CIs). Patients were classified as majority users if ≥50% of their anti-VEGF injections were with a given agent. The number of injection claims for Medicare FFS and MA patients was stratified by anti-VEGF agent and by demographic factors such as age, sex and race and ethnicity.

Results : For the FFS cohort, aflibercept 2mg was the most administered drug, comprising 43.76% of injections (n = 4,271,050), followed by bevacizumab at 34.66% (n = 3,382,439), ranibizumab at 20.58% (n = 2,008,791), brolucizumab at 0.58% (n = 56,728) and faricimab at 0.42% (n = 40,729). In contrast, for the MA cohort, bevacizumab was the most administered drug, accounting for 45.13% of all injections (n = 1,436,151), followed by aflibercept 2mg at 37.75% (n = 1,201,311), ranibizumab at 16.49% (n = 524,758), brolucizumab at 0.42% (n = 13,406) and faricimab at 0.21% (n = 6,694). A greater proportion of patients in the MA cohort were majority users of bevacizumab (low cost) injections compared to those in the Medicare FFS group (60.0% vs. 47.0% (95% CI 12.8, 13.3%; P< .001)). Conversely, the proportion of higher cost therapeutics aflibercept 2mg (28.9 vs. 36.6% (95% CI -7.9%, -7.4%; P< .001)), ranibizumab (11.9% vs. 16.80% (95% CI -5.03%, -4.72%; P< .001)), faricimab (0.06% vs. 0.24% (95% CI -0.19%, -0.16%; P< .001)) and brolucizumab (0.12% vs. 0.19% (95% CI -0.09%, -0.05%; P< .001)) were all significantly less among persons with MA, compared to those with FFS.

Conclusions : Patients enrolled continuously in MA are significantly less likely to receive higher cost and FDA-approved anti-VEGF therapeutics than patients enrolled in Medicare FFS, raising concerns for access to emerging treatments and evolving standards of care.

Volume

67

Issue

7

First Page

4176

Comments

Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, May 3-7, 2026, Denver, CO

Last Page

4176

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