Physician Choice and Step Therapy in Retinal Vascular Diseases

In “Physician Choice and Step Therapy in Retinal Vascular Diseases,” our panel explores how formulary restrictions, physician choice limitations, and step therapy policies may influence treatment selection, healthcare costs, and patient outcomes in neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO). The expert faculty discuss how utilization management strategies are intended to support cost stewardship, while also highlighting concerns about delays in accessing the most clinically appropriate anti-VEGF therapies.

During the discussion, the panel examines how restrictions on physician choice may unintentionally create inefficiencies in care delivery and potentially increase long-term healthcare costs. The expert faculty discuss treatment decisions with individual patient needs and suggest that stronger collaboration between retina specialists and payers could support more sustainable population-based care strategies.

The conversation also focuses on the practical realities of step therapy in retinal disease management. The panel reviews how many step therapy protocols require patients to first receive and demonstrate failure on lower-cost therapies, such as compounded bevacizumab, before gaining access to branded anti-VEGF agents. The expert faculty discuss how these requirements may influence treatment initiation, sequencing, and long-term disease management, particularly in patients who may benefit from earlier access to more durable therapies. Throughout the episode, the panel underscores the need for balanced approaches that consider both clinical value and economic sustainability, while also reducing unnecessary administrative barriers that may delay optimal patient care.

Our next episode, “Future Access Strategies in Retinal Vascular Diseases,” explores how emerging durable anti-VEGF therapies, investigational long-acting agents, gene therapies, and biosimilars may reshape payer strategies and treatment access. The panelists also discuss how evolving therapeutic options could influence long-term healthcare utilization, formulary design, and patient management in retinal vascular diseases.