Transforming retinal disease management through diabetes care

In September 2024, AMCP and Impact Education, LLC, held a virtual Market Insights summit with chief medical and pharmacy officers and other senior health care executives to discuss the management of retinal diseases in patients with diabetes. The summit aimed to explore the impact of current policies on treatment access and costs, identify best practices for anti-vascular endothelial growth factor (anti-VEGF) coverage, and address barriers related to social determinants of health (SDOH). Anti-VEGF therapy, although effective for conditions such as diabetic macular edema and age-related macular degeneration, may require monthly injections that impose a significant burden on patients and caregivers, affecting adherence and outcomes. Key topics included examining the impact of current policies on treatment access and total cost of care, exploring opportunities for management of patients at increased risk for blindness, outlining the benefits of durable treatment approaches, addressing strategies to overcome access barriers related to SDOH, and identifying best practices in coverage policies for anti-VEGF agents. Strategies for addressing barriers to care were explored, including the potential use of gold carding, contingent on establishing clearer definitions of good care in retinal disease management, understanding prescribing variation, gaining standardized of definitions or guidelines for good" care, and practical strategies for using extended dosing to support adherence and access. Health care executives reached agreement on the central role of ophthalmologists in preventing blindness in patients with diabetes and retinal diseases and the importance of timely access to appropriate treatments.