When a major financial assistance program for people receiving eye injections to treat age-related macular degeneration (AMD) and other retinal diseases closed its doors, it created a crisis that rippled through retina clinics nationwide. A new study shows that patients lost access to brand-name medications, faced higher out-of-pocket costs averaging over $1,100 in just six months, and had to visit their eye doctors more frequently for treatment. The findings highlight a growing gap in how affordable vision care is for lower-income Americans and those on fixed incomes.

What Happened to the Good Days Copay Program?

The Good Days program, which provided financial assistance to patients receiving intravitreal injections (shots directly into the eye) of name-brand anti-VEGF drugs, shut down due to lack of funding. These medications, which treat conditions like AMD, macular edema, and myopic choroidal neovascularization, are expensive. Medicare reimbursed $68 for a bevacizumab injection but $1,831 for aflibercept, according to 2022 data cited in the study. When the program closed, 82 patients at a Northern California retina clinic lost their copay assistance, forcing difficult choices about their treatment.

How Are Patients Coping Without Copay Help?

The study, published in JAMA Ophthalmology, found that patients adapted in three main ways after losing assistance. About 61 percent switched to bevacizumab, an off-label cancer drug repackaged by compounding pharmacies for eye use at a fraction of the cost. Another 39 percent continued with their original branded medication by relying on secondary insurance, paying out-of-pocket, or receiving repeated drug samples from their doctors. However, the financial burden proved substantial for those paying directly.

The most striking finding: patients who switched to the cheaper bevacizumab had to return to their eye doctor more often. The median time between injections dropped from 10 weeks to 7 weeks for the switched group, meaning more office visits and more time away from work or family. Over a six-month period, patients covering their copayments out-of-pocket spent an average of $1,139, a significant expense for most households.

Are Vision Outcomes Actually Affected?

Here's where the story gets complicated. The study found no significant difference in vision outcomes between patients who switched to bevacizumab and those who stayed on their original biologic drug. However, a small subset of patients, about 6 percent, did not tolerate the switch well and developed persistent retinal fluid, a sign of worsening disease. These patients had to switch back to their original medication, either by becoming dependent on drug samples or by paying higher out-of-pocket costs.

"Good Days defunding was the largest disruption to everyday treatment of AMD that we have encountered in recent years," said William M. Carrera, MD, MS, a retina specialist at East Bay Retina Consultants.

William M. Carrera, MD, MS, Retina Specialist at East Bay Retina Consultants

Researchers also observed a trend toward increasing central subretinal fluid, a biomarker of worsening disease, in patients switched to bevacizumab, though the difference was not statistically significant. The concern is that longer-term studies may reveal more serious consequences if patients continue to face financial barriers to treatment.

What Are Experts Warning About?

Eye doctors and researchers are raising alarms about the sustainability of this situation. They worry that as financial burdens increase, more patients will eventually switch to cheaper options or skip treatments altogether, leading to vision loss over time.

• Socioeconomic Disparities: A larger study of 280,000 treated eyes found that people in low-income zip codes were disproportionately affected by the loss of copay assistance, widening the gap in eye care access.
• Long-Term Sustainability: While short-term vision outcomes looked comparable between drug groups, experts warn that patients may find the treatment burden unsustainable over months and years, potentially leading to relative undertreatment and eventual vision decline.
• Supply Chain Uncertainty: The FDA is considering approval for an ophthalmic branded version of bevacizumab, which could affect the availability and cost of compounded versions that many patients now rely on.

"If patients were followed for a longer period of time, many would likely find the treatment burden unsustainable, leading to relative undertreatment and eventual visual decline," noted Christina Weng, MD, MBA, a retina specialist and researcher at Baylor College of Medicine's Cullen Eye Institute.

Christina Weng, MD, MBA, Retina Specialist and Researcher at Baylor College of Medicine's Cullen Eye Institute

What's Changing in Retina Care Right Now?

While the copay assistance crisis unfolds, the retina care landscape is shifting in other ways. Harrow, a leading provider of ophthalmic disease management solutions, recently launched BYOOVIZ (ranibizumab-nuna), an FDA-approved biosimilar to the brand-name drug LUCENTIS. As an interchangeable biosimilar, BYOOVIZ offers retina specialists another treatment option for wet AMD, macular edema following retinal vein occlusion, and myopic choroidal neovascularization. The company also holds exclusive U.S. commercialization rights to OPUVIZ (aflibercept-yszy), another biosimilar, further expanding treatment choices in the estimated $9 billion U.S. anti-VEGF market.

Additionally, Lumibird Medical introduced the IntegreLIO, described as the industry's first truly wireless integrated laser indirect ophthalmoscope system for retinal care. The lightweight, 2.2-pound device is designed to help ophthalmologists perform panretinal photocoagulation and other peripheral retinal treatments with greater mobility and comfort during extended procedures. The system features a wireless headset, foot pedal, and real-time power display projected directly into the physician's field of view. It received FDA 510(k) clearance and will debut at the American Society of Retina Specialists conference in Montreal next month.

How Can Retina Specialists Support Patients Facing Financial Barriers?

While new treatment options and technologies are emerging, the immediate challenge remains helping patients afford the medications they need. Retina specialists are adapting their practices by offering drug samples, exploring biosimilar options, and working with patients to find sustainable treatment plans. However, experts emphasize that systemic solutions, such as restored copay assistance funding or policy changes, are needed to prevent long-term vision loss in vulnerable populations.

The closure of the Good Days program has exposed a critical vulnerability in how Americans access vision-saving treatments. As retina specialists continue to innovate and expand their treatment portfolios, the underlying question remains: how can the eye care community ensure that financial hardship doesn't become the reason someone loses their sight?