Market access risk in ophthalmology

Ophthalmology is the field where a cheaper drug used off-label has set the reference price for a generation. The medicines that preserve sight in macular degeneration and diabetic eye disease are injected into the eye every few weeks, in clinics that are already full — so payers weigh each new drug on three things at once: whether it preserves more letters on the eye chart, whether it can be given less often, and how it compares with the inexpensive cancer drug that eye specialists have long repackaged for the same purpose. Beyond the retina, the field keeps asking payers to draw the line between disease and the ordinary ageing of the eye. This page brings together MARA's independent assessments of reimbursement risk across the field.

What payers ask in ophthalmology

Why pay more than the off-label standard? For the retinal diseases, the comparator is often a drug licensed for cancer, split into eye-sized doses at a fraction of the price. Payers in several countries treat it as the standard whatever the label says, and ask a new medicine to show a gain in sight — not only a licence — before they pay a premium over it.

Is fewer injections a benefit the payer pays for? An injection every four months instead of every month frees clinic capacity and spares patients. Payers recognise that value, and still ask whether vision is preserved as well over the longer interval, because a dosing advantage that costs letters on the chart is not an advantage.

Is non-inferior enough? Many trials in the eye are designed to show a new drug is no worse than the standard. Payers accept non-inferiority as grounds for reimbursement at the standard's price — and rarely above it. Where the standard is cheap, that arithmetic decides the drug's commercial life.

Where does disease end and ageing begin? Dry eye, presbyopia and the milder forms of glaucoma sit at the border of what health systems consider a medical condition. Payers ask how burden was measured, whether it is one they already treat, and whether the drug replaces something they fund — spectacles, drops, surgery — or adds to it.

The MARA record in ophthalmology

Ophthalmology holds sixteen dated assessments in the MARA catalogue: the anti-VEGF medicines in wet age-related macular degeneration, diabetic macular oedema and retinal vein occlusion, the long-acting steroid implants, glaucoma, dry eye disease, presbyopia and thyroid eye disease. Each report answers the same payer questions, carries its "as of" date, and stays on the record — when the evidence moves, a newer vintage replaces the older one visibly, never silently. Assessments are produced on MARA's own initiative for awareness; the current MARA Rating for any drug is available on request.

Current assessments (16)

For how a MARA Rating is built, see the methodology and what a MARA Rating is. To request the current rating for any drug in this area, use the contact form.