Defunding Co-Payment Assistance Disrupted nAMD Care

Maintaining positive visual outcomes in neovascular age-related macular degeneration (nAMD) is paramount in keeping patients with the condition from losing their vision. Disruptions to the delivery of those medications can potentially affect that care. A new study published in JAMA Ophthalmology emphasized the effect of those disruptions, as the defunding of co-payment assistance was associated with disruptions in care and more frequent injections.¹

Co-payment assistance for chronic conditions like nAMD was provided through Good Days through 2024. The Chronic Disease Fund for Good Days was depleted in 2024 and led to the defunding of co-payment assistance starting in 2025.² The current study aimed to assess how that loss of funding affected the delivery of on-label anti–vascular endothelial growth factor (anti-VEGF) medications, comparing the time 6 months before defunding to the 6 months after.

Patients in this retrospective study were all treated at East by Retina Consultants, with patients excluded if they were lost to follow-up, had confounding macular disease, had treatment discontinuation that was not related to futility, or had a history of macular laser treatment. Patients were all treated with a treat-and-extend strategy, and manufacturer samples were used with the discretion of the physician. Patients who switched their on-label medication with bevacizumab were sorted into the switched group, whereas those who did not switch were sorted into the same biologic group. The primary outcomes were change in best-corrected visual acuity (BCVA), injection intervals, and central subfield thickness (CST).

Optical coherence tomography imaging was completed and then assessed from June 30, 2024, through June 30, 2025. Bilateral cases defaulted to the right eyes for the analysis.

There were 110 patients included in the study, of whom 66.4% were women, and the mean (SD) age was 84.8 (5.8) years. There were 139 eyes included in the study from 1011 visits. A total of 74.5% of the patients had lost funding, totaling 82 patients. A switch to bevacizumab was made by 50 of those who lost funding, whereas 32 continued to take their original biologic. Those who continued to take their treatment did so through secondary insurance (23.2%), repeated sample use (1.2%), or payment done out of pocket (OOP) (15.9%). A total of 61 patients continued with their original medication, including those who had kept the funding for their treatment.

There were 13 patients who paid for their treatment out-of-pocket after losing funding, with their mean payment being $293.63 per injection and $1139.89 in total.

Median (IQR) CST was 225 (193-250) vs 237 (210-273) μm in the switched and biologic groups after 6 months. BCVA was 0.4 in both groups, indicating no change. Eyes in the switched group had shorter median (IQR) injection intervals compared with the biologic group (7.0 [5.0-8.0] vs 10.0 [8.0-14.0] weeks). Change in BCVA or CST after 6 months was not associated with switching treatment. However, worse baseline BCVA and greater number of injections were associated with less improvement in BCVA.

There were some limitations to this study, including that it was conducted at a single center, it had short duration, the design was retrospective, and generalizability to other practice settings was not known.

The researchers noted that the impact of the expenses of the treatment will likely affect patients with lower income or who are older adults on fixed incomes. Higher-risk eyes could be at an increased risk after switching treatment due to the loss of funding. “Switching to bevacizumab from anti-VEGF was associated with greater injection frequency, comparable short-term visual and structural outcomes, increased reliance on unsustainable sample supply, and higher patient OOP costs,” the authors concluded.

References

1. Carrera WM, Zeng A, Cheong KX, Hoang QV, Jung JJ, Rofagha S. Outcomes in neovascular age-related macular degeneration after copayment assistance defunding. JAMA Ophthalmol. Published online June 18, 2026. doi:10.1001/jamaophthalmol.2026.2093
2. Good Days Patient Assistance Program Update & FAQs. Retina Consultants. Accessed June 19, 2026. https://www.fargoretina.com/good-days