Higher-cost therapies for age-related macular edema (ARMD) were significantly more likely to be prescribed by ophthalmologists accepting manufacturer payments.
High-cost treatments for age-related macular degeneration (ARMD) were more likely to be prescribed by ophthalmologists who accepted drug manufacturer payments, according to a study published in JAMA Ophthalmology. These costly therapies are a factor in increased spending by both patients and Medicare.
ARMD is treated through the use of anti–vascular epithelial growth factor (VEGF) agents: bevacizumab, ranibizumab, and aflibercept, in increasing order of cost. Health care practitioners are reimbursed for administering drugs based on the average sales price through the Medicare Part B program. This study aimed to “assess the association between manufacturer payments to ophthalmologists and choice of ARMD treatment.”
Data were collected from the Medicare Physician and Other Practitioners files from 2013 to 2019, available from CMS. Ophthalmologists were included in the study if they identified as ophthalmologists and had billed Medicare for any of the 3 anti-VEGF drugs of interest.
There were 21,584 ophthalmologists included from 2013 to 2019, 14.3% of whom were women and 74.5% of whom accepted manufacturer payments. The use of bevacizumab decreased from 39.9% to 31.2% from 2013 to 2019 in ophthalmologists overall. The proportion of ophthalmologists who accepted payments from either Regeneron Pharmaceuticals Inc (the manufacturer of aflibercept) or Genentech Inc (the manufacturer of bevacizumab and ranibizumab) varied throughout the years, with a low of 15.0% and a high of 34.3%.
Lower bevacizumab use was associated with accepting payments from Regeneron or Genentech. Estimated bevacizumab use was 28.0% (95% CI, 24.6%-42.5%) in ophthalmologists who accepted manufacturer payments compared with 45.8% in ophthalmologists who did not accept payments (95% CI, 44.5%-47.1%).
Lower bevacizumab prescribing was also associated with accepting research funding from the 2 corporations, with ophthalmologists who accepted only research funding prescribing bevacizumab 18.9% (95% CI, 11.6%-65.4%) of the time compared with 45.8% among ophthalmologists who did not accept manufacturer payments (95% CI, 44.5%-47.1%). Prescription of bevacizumab in ophthalmologists who accepted nonresearch payments was 28.3% (95% CI, 7.3%-42.5%).
Medicare spending would have been $642,779,703.08 lower from 2013 to 2019 if ophthalmologists who had accepted payments had prescribed in the same way as ophthalmologists who did not accept manufacturer payments, which would have been a 2.0% reduction in spending on treatments for ARMD. Bevacizumab would have had 3.2% higher usage in the course of the study period compared with the observed use (40.3% vs 37.1%).
There were a few limitations to this study. There are differences in billing for off-label bevacizumab, which could affect estimates of cost. Patient characteristics reflected ophthalmologists’ entire patient mix, not just those with ARMD. Practice-level outcomes that could be associated with the choice of the ophthalmologist were not able to be accounted for. This study was also observational in nature.
The researchers concluded that ophthalmologists who accepted manufacturer payments were overall more likely to prescribe therapies that carried a higher cost. This affected cost of treatment for ARMD, as Medicare could have reduced spending by more than $642 million from 2013 to 2019 if all ophthalmologists had prescribed similarly to those who did not accept manufacturer payments.
Dickson SR, James KE. Medicare Part B spending on macular degeneration treatments associated with manufacturer payments to ophthalmologists. JAMA Ophthalmol. 2023;4(9):e232951. doi:10.1001/jamahealthforum.2023.2951