Regeneron’s Eylea and Genentech’s Lucentis Are Equally Likely to be Covered on Commercial and Medicare Advantage Plans for Wet AMD

BURLINGTON, Mass., Sept. 18, 2014 /PRNewswire/ -- Decision Resources Group finds that Regeneron's Eylea, the most recently launched anti-vascular endothelial growth factor (VEGF) agent for wet AMD, is equally likely to be covered on commercial and Medicare Advantage plans as Genentech's Lucentis, which is the standard of care for wet AMD. Of note, although surveyed managed care organization (MCO) directors do not identify a clear clinical or economic advantage with Eylea, Eylea is slightly more likely than Lucentis to be listed on tier 1 or 2 on Medicare Advantage plans, the primary private insurance type for the wet AMD patient population, thus potentially facilitating access for patients covered by this plan.

Other key findings from the U.S. Physician and Payer Forum report entitled Anti-VEGF Agents: How Does Cost Versus Dosing Impact the Wet AMD Treatment Algorithm Among Retinal Specialists in the United States?:

• Impact of biosimilar ranibizumab: Assuming biosimilar ranibizumab demonstrates comparable efficacy to Lucentis in wet AMD clinical trials and was priced at a 20 percent discount, the majority of surveyed payers would reimburse the agent on their plans within a year of availability, with at least some MCOs likely to place biosimilar ranibizumab on more-favorable formulary tiers than Lucentis and Eylea. Given that surveyed retinal specialists also appear receptive to incorporating biosimilar ranibizumab into their practices, use of all the major anti-VEGF agents will likely be impacted if a biosimilar ranibizumab launches.
• Most-effective market access levers: Demonstration of superior head-to-head efficacy versus standard of care, especially a greater effect on visual acuity, represents one of the most influential routes for new wet AMD therapies to gain formulary inclusion/placement and preferred tier status. This finding bodes well for the emerging agents, specifically Ophthotech's Fovista and Ohr Pharmaceuticals' Squalamine, which have early data suggesting improved visual acuity when compared with Lucentis monotherapy.

Comments from Decision Resources Group Analyst Emma McFadden, Ph.D.:

• "Emerging wet AMD therapies including Fovista and abicipar pegol (Allergan/Molecular Partners) will need to be priced competitively to Eylea and Lucentis in order to garner favorable tier placement. Indeed, payers were much more likely to exclude or NDC block these therapies as hypothetical annual cost increased, indicating that they perceive these agents as being valuable treatment options for wet AMD up to a certain price point, after which their clinical advantages do not outweigh the additional cost."
• "Developers of new wet AMD therapies may face challenges when drug attributes that drive physician prescribing differ from those that drive payers' formulary inclusion decisions. As an example, while less frequent dosing than current anti-VEGF agents is the top developmental goal for surveyed retinal specialists, relatively few payers selected achievement of this goal as likely to lead to preferred tier status for a new therapy."

About Decision Resources Group
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SOURCE Decision Resources Group