Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) reduce visual acuity and can severely decrease a patient’s quality of life. But both conditions have similar treatments, and managed care pharmacists can make an impact on treatment and health outcomes, which was the focus of “The Evolving Strategies for Managing nAMD and DME” session at Academy of Managed Care Pharmacy (AMCP) Nexus on Oct. 15. The session began with a high-level review of these conditions and treatment protocols from Joshua Mali, M.D., a vitreoretinal surgeon at the Paul Phillips Eye & Surgery Center in Flemington, New Jersey.

As Mali described, age-related macular degeneration (AMD) can lead to severe visual impairment and blindness, and it impacts around 10% of people aged 80 and older. DME is the leading cause of vision loss for people living with diabetes.

If it is caught quickly, Mali noted, treatments can be effective to improve visual acuity, and both nAMD and DME can be treated with injected therapies. However, current therapies do have their limitations, including anxiety about drugs being injected into the eye, but affordability and frequency of treatment —generally administered every couple of months — have an impact.

In a study of nearly 900 individuals, patients with nAMD had a median of 18 injections and 21 clinic visits over three years. But for older patients on a fixed income, and with the cost of therapy being relatively high, non-adherence is common. Read more about the costs of injected eye therapies in the AMCP Nexus study by David Eckwright, PharmD, MHI, CSP, senior director of clinical project and program management and team. 

But as Mali noted, the objective is to minimize treatment burden and maximize outcome, which is where managed care considerations can help. As YuQian Liu, PharmD, RPh, senior director of clinical account services at Prime Therapeutics (Prime) described, ophthalmic injections account for the second highest per member per month (PMPM) spend on Medicare, according to the 2023 Prime Medical Pharmacy Trend Report.

Real-world studies of faricimab-svoa (Vabysmo^®) show that longer injection intervals are associated with decreased treatment adherence. Longer treatment intervals do have benefits, but patient follow-up is crucial.

“Is it a problem with the products? Absolutely not,” Liu said. “This is where managed care providers … can drive adherence and see the fullest health outcome possible.” 

Treat-and-extend strategies are most effective, leading to greater patient convenience, increased visual acuity, lower costs to the patient and fewer patient consultations.

Additional management opportunities — including targeted adherence programs, low cost alternatives and a sound biosimilar strategy — are among the more effective tactics in the managed care space, Liu explained.

“This is where managed care professionals can come together to find a solution on improved outcomes,” Liusaid. And as more competition enters the market, drug therapies will continue to be more affordable. But, as Liu shared, driving drug adherence will be essential to keep costs in line.

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Stay tuned for more AMCP Nexus 2024 in focus content throughout the week in the Prime newsroom.