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Survey of 150+ leading retina specialists edited by Andrew A. Moshfeghi, MD, MBA

PERSPECTIVE

For suboptimal responders who

have persistent macular uid de-

spite monthly anti-VEGF therapy

or 1 year, I recommend they con-

sider Eylea (aibercept, Regener-

on) to see i this VEGF rap agent

works better or them than their

anti-VEGF agent, which, or most

o my patients, is usually Avastin

(bevacizumab, Genentech). While

my interpretation o the current study data or our

anti-VEGF and VEGF-trap options is that, on average,

visual outcomes seem to be roughly the same, indi-

vidual patients may very well respond dierently to the

dierent drugs. Tereore, it seems reasonable to see i

Eylea results in greater resolution o macular uid in

this subset o persistently wet patients. However, I also

inorm patients who do respond nicely to anti-VEGF

therapy about the availability o Eylea therapy because,

regardless o whether I believe Eylea is cost-eective,

I believe that I have the responsibility to allow my pa-

tients to make an inormed decision regarding whether

the reduced requency o oce visits is worth the much

higher drug costs to them.

With that said, I make it clear that based on the

data I have seen thus ar, I believe all three drugs are

equally likely to preserve or improve their vision, and I

recommend they base their treatment decision on their

weighting o the ollowing issues: 1) the impact o any

dierential out-o-pocket costs; 2) the value, to them,

o cutting monthly oce visits in hal when receiving

Eylea therapy with the understanding that, on aver-

age, the number o injections per year with Eylea will

be only slightly less than with as-needed anti-VEGF

therapy, as dened in the CA; and 3) their level o

concern regarding the negative nancial impact on

Medicare and society o choosing a drug that costs ap-

proximately $11,000 per year over a drug that I believe

has equivalent visual benets at approximately $400

per year.

It will be interesting to see which therapy most patients

select when we revisit this issue in 6 months. John S.

Pollack, MD

Disclosure: Dr. Pollack receives the Genentech Lucentis rebate

program.

PERSPECTIVE

In the OSN Retina survey, not sur-

prisingly only 41.2% o retina spe-

cialists state that they will only use

Eylea (aibercept, Regeneron) afer

perorming an initial benets in-

vestigation, even though this would

be without a permanent J code as-

signed and without rm coverage

decisions rom third-party payors.

Tis response means that physi-

cians are eager to use it but need to do so in a scally

responsible ashion. Physicians want to be able to pro-

vide their appropriate patients with Eylea but have tomake sure the drug is either reimbursed or replaced.

Tis approach ofen means the patient may ultimately

be responsible or several months worth o medica-

tion should his or her insurance company decide not to

pay and/or the patient-assistance programs sponsored

by the drug industry all through. I elt strongly about

making Eylea available to my most recalcitrant neovas-

cular AMD patients, especially insoar as patients have

long been anticipating a new entrant into the AMD

marketplace. I have rst oered Eylea to patients who,

despite aggressive monthly dosing o Lucentis (ranibi-

zumab, Genentech) or Avastin (bevacizumab, Genen-

tech), still have persistent macular uid or hemorrhage.

Tat said, I still worry about reimbursement and have

only administered Eylea or those with a thorough un-

derstanding o the nancial implications.

A slightly greater number o physicians (50%) eel

that a higher level o assurance is required beore pro-

viding Eylea to their patients, requiring a local coverage

decision by each carrier to be in place beore adminis-

tering the new treatment. O course, this could occur

at any time but may take 6 months or longer in many

cases. A permanent J code or Eylea is not anticipated

until at least January 2013; thereore, in the meantime,

physicians have to use the generic J3490 o J3590 orunspecied drugs and biologics, respectively. Until the

permanent J code is in place, persistent reimbursement

issues will continue, such as no reimbursement, delayed

reimbursement or multiple requests or additional doc-

umentation prior to reimbursement. Regenerons ability

to provide a robust reimbursement-assistance program

or practices and patients will be tested during this

rst year o Eylea availability. Andrew A. Moshfeghi,

MD, MBA

Disclosure: Dr. Mosheghi is a consultant or Genentech, Allergan

and Alcon.

Andrew A. Mosheghi

John S. Pollack

How do you plan to incorporate Eylea into the management o yourwet AMD patients during the frst 6 months o 2012?

With respect to Eylea reimbursement and the use o thegeneric J code, how do you plan to use Eylea in the

management o your wet AMD patients in 2012?

58.8%

32.4%

2.9% 5.9%

50%

41.2%

2.9% 5.9%

I will not use Eylea at all.

I plan to switch all new patients to Eylea.

I will only use Eylea or patients who were

suboptimal responders to aggressive anti-VEGF

therapy with Lucentis or Avastin.

None o the above.

I will not use Eylea at all.

I will not use Eylea until a permanent J code

has been assigned.

I will not use Eylea until coverage decisions by

CMS and other carriers have been set.

I will use Eylea ater perorming an initial

benefts investigation even though a J code

has not been assigned and coverage decisions

are still lacking.

OCULAR SURGERY NEWS|JANUARY 25, 2012|OSNRetina.com0