(173) Payer-identified practice gaps and educational needs in the management of retinal diseases: improving outcomes with streamlined referral to specialists and earlier access to treatments

Background: : Anti-vascular endothelial growth factor (anti-VEGF) therapies are considered first-line treatment in the management of retinal diseases such as age-related macular degeneration (AMD) and diabetic retinopathy (DR). Many current payer coverage policies include a step therapy protocol requiring a first-line trial of off-label bevacizumab prior to accessing FDA-approved anti-VEGF agents. Payers may benefit from medical education to continuously improve coverage policy and utilization management interventions.

Objective: : To assess payer-perceived practice gaps and educational needs in the management of retinal diseases and identify opportunities for improved access and outcomes.

Methods: : Two surveys were distributed by Impact Education, LLC, to managed care professionals regarding educational needs in the management of AMD (n=28) and DR (n=45) in January 2025. Results were compiled and compared to assess payer-perceived gaps in knowledge and practice.

Results: : Delayed referral to retinal specialists was the most common reported deviation from standard of care in both AMD (64%) and DR (56%). Earlier access to FDA-approved anti-VEGF agents in patients affected by social determinants of health was the most frequently chosen gap in patient access that needed to be addressed for both AMD (64%) and DR (58%). For AMD, the next most cited gap was the need to remove prior authorization to access formulary preferred bevacizumab (46%); while for DR, it was the need for earlier access to FDA-approved anti-VEGFs for patients based on disease severity (51%). Excessive documentation to meet prior authorization criteria was ranked as the most prominent barrier to high-quality retinal disease management in both disease states (average rank: 2.0). Payers cited improved efficacy as the most valuable attribute of FDA-approved anti-VEGF agents over bevacizumab in both disease states (AMD average rank: 2.2; DR average rank: 1.8). Greater durability of treatment effect was the next most valuable attribute for both disease states (average rank: 2.6 for both).

Conclusions: : Managed care professionals identified consistent gaps in timely referral, access to FDA-approved anti-VEGF therapies, and burdensome PA processes across both AMD and DR. These findings point to opportunities for targeted policy refinement and streamlined utilization management strategies for anti-VEGF agents.

Sponsorship:: Regeneron Pharmaceuticals, Inc.