Loading ...

A funding shortfall for a key copay assistance program to help make eye injections more affordable for low-income patients has caused widespread disruption in treatment, researchers have found.

Good Days is a nonprofit charitable organization set up to help people on Medicare who have retinal disease and other chronic conditions cover copays for treatments, such as intravitreal injections to treat age-related macular degeneration (AMD), diabetic macular edema, diabetic retinopathy, and geographic atrophy. Retina practices have reported the program, which receives financial support from Regeneron, stopped accepting new enrollees in 2025. According to the group’s 2024 financial statements, Good Days — an arm of the Chronic Disease Fund, Inc. — provided funding to more than 422,000 patients that year and reported more than $480 million in contributions and grants.

The new analysis, of more than 280,000 treated eyes in a national database of electronic health records, found people in low-income zip codes have been disproportionately affected by the loss of assistance.

“There is clear evidence that the loss of copay assistance triggered widespread disruptions in evidence-based care,” Ghassan Ghorayeb, MD, MBA, a vitreoretinal specialist at West Virginia University in Morgantown, West Virginia, told Medscape Medical News. Ghorayeb presented the findings at the 2025 meeting of the American Society of Retina Specialists (ASRS) 2025 Annual Meeting in Long Beach, California.

Ghorayeb said he and colleague Philip Niles, MD, MBA, undertook the two-part study — a survey of ASRS members paired with an analysis of real-world data — after “the abrupt underfunding” of the Good Days program in late 2024.

Most Vulnerable, Most Harm

The analysis used electronic health record data from 340 retina specialists in 68 US practices collected from January 2024 to June 2025. The study included 146,551 eyes treated for AMD, 113,375 treated for diabetic macular edema, and 95,925 treated for geographic atrophy.

The analysis calculated the effect of the funding shortfall on people who had switched out of more costly branded treatments to off-label bevacizumab (Avastin), which can cost between $50 and $80 per injection before copays. Bevacizumab is a cancer drug compounding pharmacies repackage for off-label ocular administration. Medicare and Medicaid cover the off-label use for retinal disease.

According to a schedule posted by Retina Specialty Institute, a retina practice in three Southeastern states, out-of-pocket costs for branded intravitreal injections can range from $88 and $137 for ranibizumab 0.3 and 0.5 mg to $558 for a ranibizumab biosimilar and $537 for aflibercept 8 mg.

“We saw significant increases in off-label Avastin switching, sample reliance, and treatment discontinuation,” Ghorayeb told Medscape Medical News. “These shifts were not benign: real-world data and physician surveys both linked them to higher rates of visual decline, particularly in economically disadvantaged zip codes. The most vulnerable patients experienced the most harm.”

The analysis found switching from branded drugs to lower-cost bevacizumab has increased 45.6% for AMD and 37% for diabetic macular edema from 2024 to 2025, Ghorayeb reported. That translated into an increase in vision loss of 26% for the former patients and 19% for the latter.

Clinicians in the study also relied more on using samples of medicines that were previously reimbursed, with a 44% increase for AMD injections, 8.3% for diabetic macular edema, and 203% for geographic atrophy, Ghorayeb said.

While injections for geographic atrophy increased by 40% from 2023 to 2024 as new agents won FDA approval, injections for the indication have declined by 1% so far in 2025, he said.

The study also tracked what Ghorayeb described as “unsustainable” practices in clinics, when patients receive multiple samples of the same drug in a single eye or were switched to off-label bevacizumab despite declining vision with the drug. “We found a sharp increase in unsustainable care patterns across the board, more than 30% in diabetic macular edema and hovering around 60% in wet AMD and geographic atrophy,” he told attendees at the meeting.

Vision decline after switching from on-label therapies to bevacizumab were 44% more common in lower-income zip codes, Ghorayeb said.

‘Not Marginal Effects’

“These are not marginal effects,” Ghorayeb told Medscape Medical News. “They reflect real harm attributable to affordability-driven treatment changes.”

Programs such as Good Days are “fundamental to equitable care delivery,” he said. “Even patients with Medicare or Medicare Advantage were unable to maintain their treatment regimens without supplemental support. Loss of assistance led to downgraded therapy, missed injections, and vision loss. We believe that maintaining copay support is a clinical and economic imperative.”

Looming Medicaid cuts and reductions in Medicare reimbursements “could tip the balance from unsustainable to untenable,” Ghorayeb said. “Without systemic support, we risk abandoning our most vulnerable patients and undermining the gains made in treating retinal disease over the past two decades.”

The study underscores a broader truth, he added: “When the cost of care becomes a barrier, outcomes suffer.”

“The study findings show that the economics of intravitreal injections are extremely fragile and tightly tethered to copay assistance programs,” Michael Lai, MD, PhD, a retina specialist at the Retinal Group of Washington, DC, told Medscape Medical News. “A significant number of Medicare and Medicare Advantage patients depend on supplemental financial support to obtain necessary vision-saving retinal therapies.”

The study demonstrated that disparities of care in lower-income communities “are even greater than we had assumed,” Lai said.

“The underfunding of Good Days caught many patients and retina specialists off guard,” he added. “All of the coping mechanisms we have resorted to so far, including switching to repackaged Avastin, using free samples and skipping or postponing injections, are unsustainable.”

“I sincerely hope that the information and data from this presentation will motivate all relevant stakeholders including industry partners, policymakers, and our societies to come together to find a solution to help our patients.”

Ghorayeb had no relevant disclosures. Lai had served as a consultant to Apellis Pharmaceuticals.

Richard Mark Kirkner is a medical journalist based in Philadelphia.