Payer Considerations for GA Therapy Options


Dr Lopes provides insights into payer considerations when navigating geographic atrophy treatment pathways.

Ryan Haumschild, PharmD, MS, MBA: We have provider education, which I think is really important and I think there will be uptake. And as you said, there’ll be early adopters, but I think there’s also a lot of payer education because one of the things I heard you say is we have to make sure that these therapies get reimbursed. We have to make sure they’re covered. Dr Lopes, from your perspective, what information should payers also know about these therapies when they’re making coverage decisions?

Maria Lopes, MD, MS: Well, the first is, what is GA [geographic atrophy]? So putting a face to what GA represents in terms of what you actually see or don’t see with GA. So the central vision loss I think really hits home in terms of the degree of unmet need and how impactful this disease is. It’s so clear when you see what central vision loss would represent if you had it in terms of functional impairment. The other is the whole education around the right patient. So early matters one of the concerns is going to be who’s going to make the diagnosis? And we probably don’t have enough retinal specialists. I think that in itself is going to be a bottleneck. How are these patients going to be referred, properly diagnosed, assessed, and treated? It’ll be helpful to payers if we understand the disease, how you make the diagnosis, the degree of unmet need, and what these treatment options offer. So to go over the clinical trials as we heard. And also very, very importantly, how slowing the main growth of progression is going to ultimately impact vision loss. I’m excited to hear about forthcoming data. Ultimately, I think that’s also what patients want to understand—what does this mean for me? Hopefully, we’ll have better also predictive tools. Is the rate of progression being affected? And also as we look at these treatments, what does slowing progression mean or lesion growth mean with respect to vision loss? Also interesting is going to be the frequency of administration. There wasn’t a lot of difference between the monthly and every other month. And as a payer, certainly, we would look at the vision loss to hopefully answer that question of whether should it be every month. It potentially doubles the cost. What is the incremental benefit monthly vs every other month? So hopefully that’s forthcoming. And then once we have multiple treatment options, how do they compare in terms of not just the study population but how does the data compare across different trials in terms of clinical benefits? Overall, it's exciting to see treatment options where there haven’t been any. But at the same time, a lot of education is needed, the right support, and the right tools for payers as well as providers to properly identify and refer patients in a timely manner. And then reassess. We’re back to then reassessing whether a treatment is really beneficial and having the desired impact or not in the context of risk vs benefit. Also, do you treat bilaterally? Do you just treat 1 eye? Again, at what point do you initiate treatment, if both eyes are at risk, at what point do you do that? I think we’re all learning from this. It’s great to have options and hopefully more data, especially real-world data, that attracts these patients longer term is going to be able to answer some of these questions.

Transcript edited for clarity.

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