Targeted Management of Excess Specialty Spending: The Case of Biologics for Retinal Disease

Abstract

Summary Injectable biologics used for the treatment of retinal disease offer a strong use case for ACOs, payers, and policy makers as they seek to manage total costs by reducing costly practice variation and avoidable Medicare Part B drug spending. Bevacizumab, which was originally approved by the U.S. FDA in 2004 for the systemic treatment of advanced colon cancer, has seen increased off-label utilization as a vascular endothelial growth factor (VEGF) inhibitor for retinal disease. Three anti-VEGF medications that are commonly used for retinal disease each have similar outcomes in clinical trials but have notably different average costs (in USD) per injection: bevacizumab, $90; ranibizumab, $1,883; and aflibercept, $2,098. Based on these and other factors, leaders at CommonSpirit Health, a large national nonprofit health system operating in 21 states, propose and model a reduction of clinical practice variation to a standard of care for this single indication to represent a $2.3 billion annual savings opportunity for Medicare.