OAKLAND — A prospective study of 110 older patients at a Northern California retina practice found that three-fourths lost copayment support for neovascular age-related macular degeneration (nAMD) drugs after the Good Days Chronic Disease Fund depleted its resources. The loss of funding prompted many patients to transition to lower-cost treatment alternatives.

Records showed 82 patients lost copayment assistance. Of those, 50 switched to bevacizumab, while three later reverted to their original treatment due to persistent fluid accumulation. Nineteen patients continued their existing biologic medication using secondary insurance, 13 covered the additional out-of-pocket costs, and one used samples.

The study observed no adverse effects on visual acuity or retinal anatomy during the six-month follow-up period. There was no difference in median central subfield thickness or best corrected visual acuity between patients who switched to bevacizumab and those who did not. However, patients who switched required more frequent treatment, with a median interval of 7.0 weeks compared to 10.0 weeks for those who did not switch.

Soraya Rofagha, MD, MPH, a researcher in the study, 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." Regarding costs, 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." She noted that her practice currently has 22 patients on a waitlist, adding, "If we are lucky, we can get about five patients enrolled before it closes."

A survey summary presented at the American Society of Retina Specialists (ASRS) meeting indicated that 61% of respondents reported patients experiencing vision loss due to cost-related treatment delays following the depletion of the fund. A similar percentage linked the depletion to patients being lost to follow-up, and three-fourths noted the loss disproportionately affected lower-income and underserved communities. An analysis of electronic health records for 280,000 treated eyes, also presented at the meeting, showed worse vision outcomes when patients switched to lower-cost therapies and relied on samples.

Michael Lai, MD, PhD, stated, "The underfunding of Good Days has caused widespread treatment disruptions for Medicare-aged patients with retinal diseases, particularly in low-income areas." He added, "Retina specialists report a growing dependence on less effective treatment alternatives, delays in care, complete discontinuation of therapy, and patient harm." Lai said, "Copay assistance programs play a critical role in access to retinal therapy and preservation of vision," and "There is an urgent need to restore adequate funding." He noted that many practices have devoted staff resources to monitor fund availability: "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." He concluded, "This adds to our overhead costs, because this is uncompensated work." Standard Medicare covers 80% of nAMD drug costs, requiring patients to cover the remaining 20% unless they have supplemental coverage.