OAKLAND — A recent study published in JAMA Ophthalmology found that 75% of patients with neovascular age-related macular degeneration (nAMD) at a Northern California retina practice lost copayment support following the depletion of the Good Days Chronic Disease Fund. This loss of support led to changes in medication and increased treatment frequency for some patients.

Overall, 82 of the 110 patients in the study cohort lost copayment assistance, with 50 of those patients switching to bevacizumab. Three patients who switched to bevacizumab later reverted to their previous medication due to persistent fluid accumulation. Soraya Rofagha, MD, MPH, of East Bay Retina Consultants, whose group had about 200 patients receiving support prior to the funding depletion, 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."

Patients who switched to bevacizumab required treatment every 7.0 weeks, compared to 10.0 weeks for those who did not switch. At 6 months of follow-up, no differences were observed in median central subfield thickness or best corrected visual acuity between patients who switched medications and those who did not. Among patients who retained access to their existing biologic medication, 19 used secondary insurance, 13 paid additional out-of-pocket costs, and one repeatedly used samples. The average out-of-pocket cost for patients in the cohort over 6 months was $1,139.89.

Michael Lai, MD, PhD, of the Retina Group of Washington, stated, "The underfunding of Good Days has caused widespread treatment disruptions for Medicare-aged patients with retinal diseases, particularly in low-income areas." Dr. Lai added, "Retina specialists report a growing dependence on less effective treatment alternatives, delays in care, complete discontinuation of therapy, and patient harm." He said copayment assistance re-enrollment windows sometimes close within a few days or hours due to rapid fund depletion.

A survey of American Society of Retina Specialists (ASRS) members indicated that 61% of respondents had patients with vision loss linked to cost-related treatment delays after the Good Days Chronic Disease Fund was depleted. A similar proportion of ASRS survey respondents connected the funding depletion to patients being lost to follow-up, and three-fourths of respondents stated the loss of support disproportionately affected lower-income patients and those from underserved communities. An analysis of electronic health records for 280,000 treated eyes, presented at the ASRS meeting, showed worse vision outcomes associated with switching to lower-cost therapy and relying on samples.

Why It Matters

The depletion of copayment assistance funds for neovascular age-related macular degeneration (nAMD) patients leads to medication switches and increased treatment frequency, which can financially impact patients. Good Days and other nonprofit organizations have received additional funding for copayment assistance, though this funding has been quickly depleted. Currently, Dr. Rofagha's practice has 110 patients receiving assistance and 22 on a waitlist, with a staff member monitoring the fund multiple times daily. "If we are lucky, we can get about five patients enrolled before it closes," Rofagha said.

This situation affects patients, particularly those with lower or fixed incomes, as they face substantial out-of-pocket expenses. Dr. Rofagha said, "Our findings also suggest that higher-risk eyes may be placed at increased risk following switching due to funding loss." She added, "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." Dr. Lai stated, "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." A Regeneron spokesperson has stated that a previously announced $200 million donation matching fund for Good Days remains active.