Age-related macular degeneration (AMD) is the leading cause of legal blindness in adults over age 50. The development of agents that target vascular endothelial growth factor (VEGF) has revolutionized the treatment of AMD. Currently, three FDA-approved agents (ranibizumab, aflibercept, and brolucizumab) and one off-label anti-VEGF agent (bevacizumab) are being used to treat patients with AMD. Additionally, data from emerging anti-VEGF agents have demonstrated efficacy in improving visual acuity in these patients. However, optimal AMD management is impeded by challenges in access to FDA-approved therapies.

In an effort to control health care costs, payers use multiple mechanisms to steer the patient towards less expensive therapies. Step therapy, also known as “failed first protocol” or “tiered therapy” or “graduated therapy” is a type of prior authorization (PA) instituted by the payer that mandates that more cost-effective therapies be used before more expensive alternatives in a stepwise approach. Prior authorization can be burdensome on providers especially if streamlined processes are not implemented within the clinical workflow.

The CME Outfitters, LLC Ophthalmology Hub is designed to provide clinicians with the latest guidelines to optimize the management of patients with AMD and resources on step therapy. In addition, the Ophthalmology Hub also includes a patient whiteboard that educates patients on the step therapy process.

Activities

Keeping the Patient in the Center in AMD Care

Participate NowThe first part of this CME Outfitters Snack series on overcoming the challenges of prior authorization when treating patients with AMD features expert faculty discussing how to implement patient-centric care models that incorporate shared decision-making, which is imperative to educating patients on the benefits and risks of FDA-approved and off-label agents for the treatment of AMD.

Minimizing the Burden of Prior Authorization in AMD Through Actionable Strategies and Improved Communication

Participate NowIn order to decrease the burden of PA for AMD treatments, the second module of this CME Outfitters Snack series aims to provide learners with strategies to improve documentation and establish clear communication with the payer to minimize treatment delays.

Honing in on the Appeal Process to Improve Access to Anti-VEGF Therapy for Patients with AMD

Participate NowStep therapy requirements have limited patient access to FDA-approved, anti-VEGF agents for the treatment of AMD. Prior authorization requests for these therapies are commonly denied. Hence, it is important that clinicians be aware of the approaches to overcome these barriers and implement systemic and clinically supported appeals that ensure uninterrupted anti-VEGF therapy for patients with AMD. In the third module of this CME Outfitters Snack series, expert faculty focus on developing and implementing strategies for appeals in order to reduce treatment delays.

Zooming in on the Education and Empowerment of Patients in AMD Care

Participate NowThe final module of this CME Outfitters Snack series describes step therapy policies and their implications for the patient, with the goal of educating clinicians on the increased risk of these policies, including the possibility of increased medical costs and worsening of the disease, so that they can pass this knowledge on to their patients with AMD and work together to navigate through the PA process.
Patient Resources

Animated Look at Prior Authorization in AMD

Download Animated Look at Prior Authorization in AMD