Step Therapy Associated With More Switching of Anti-VEGF Treatment, Study Finds

CMS started allowing Medicare Advantage (MA) plans to implement step therapy for physician-administered Part B drugs in 2019. Health insurers' step therapy policies require patients with certain conditions to be treated with particular drugs before they “step up” to other drugs that are presumably more expensive for the insurer to cover. The anti-vascular endothelial growth factor (VEGF) injections used to treat retinal conditions, such as neovascular (wet) age-related macular degeneration and diabetic macular edema, have become prime targets of Medicare Advantage step therapy — and prior authorization — policies as their use and share of Part B spending have grown. A study published in JAMA Health Forum in 2023 identified Eylea (aflibercept) as the second most expensive drug by total sp