OAKLAND — A prospective study involving 110 patients at a Northern California retina practice found that three-fourths of participants lost copayment assistance for neovascular age-related macular degeneration (nAMD) drugs following the depletion of the Good Days Chronic Disease Fund. The disruption led to treatment changes and increased out-of-pocket costs, though no decline in visual acuity or retinal anatomy was observed over six months.

The retrospective review of records from June 2024 to June 2025 included 139 treated eyes in a population with a mean age of 85, where women accounted for two-thirds of patients. Records showed that 82 patients lost copayment assistance. Approximately half of these patients, 50 individuals, switched to bevacizumab. Three patients who switched to bevacizumab later returned to their original medication due to persistent fluid accumulation. Patients who lost funding became reliant on drug samples or incurred higher out-of-pocket expenses, with the average out-of-pocket cost for patients in the cohort reaching $1,139.89 over six months.

Soraya Rofagha, MD, MPH, of East Bay Retina Consultants, said, "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." She added, "Our findings also suggest that higher-risk eyes may be placed at increased risk following switching due to funding loss." Rofagha stated, "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."

Patients who switched to bevacizumab required more frequent treatment, with a median treatment interval of 7.0 weeks compared to 10.0 weeks for those who did not switch. After six months, there was no difference in median central subfield thickness or best corrected visual acuity between the groups. Patients with worse baseline visual acuity and those needing more frequent injections showed less improvement in vision.

An American Society of Retina Specialists (ASRS) member survey indicated that 61% of respondents reported patients experiencing vision loss linked to cost-related treatment delays after the Good Days CDF depletion. Three-fourths of ASRS survey respondents observed that the loss of copayment support adversely affected lower-income patients and those from underserved communities. An analysis of electronic health records for 280,000 treated eyes independently showed worse vision outcomes associated with switching to lower-cost therapy and relying on samples.

Michael Lai, MD, PhD, of Retina Group of Washington, said in a podcast interview, "The underfunding of Good Days has caused widespread treatment disruptions for Medicare-aged patients with retinal diseases, particularly in low-income areas." Lai added, "Retina specialists report a growing dependence on less effective treatment alternatives, delays in care, complete discontinuation of therapy, and patient harm." He stated, "Copay assistance programs play a critical role in access to retinal therapy and preservation of vision." Lai said, "There is an urgent need to restore adequate funding." Regarding fund availability, Lai said, "Unfortunately, the bad news is the funding has not been enough." He noted, "At the moment, the funding these organizations received has been depleted." Lai explained, "What happens is that periodically, funds become available, and the [copayment assistance] opens up for re-enrollment." He added, "But the window for re-enrollment will be very short, because the funds get depleted so quickly." Lai said, "Sometimes the window closes within a few days or sometimes even within a few hours." He noted, "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." Lai concluded, "This adds to our overhead costs, because this is uncompensated work."

Regeneron previously announced a $200 million matching fund for Good Days, and a spokesperson said in a podcast interview that the funding program is still active. Rofagha's practice, which had about 200 patients receiving CDF assistance prior to funding depletion, currently has 110 patients receiving assistance and 22 on a waitlist. Rofagha's practice employs a staff member who monitors the CDF multiple times a day. Rofagha said, "If we are lucky, we can get about five patients enrolled before it closes."