The demise of a copay assistance program for people who receive eye injections for retinal diseases has disproportionately raised out-of-pocket costs for lower-income patients and those on fixed incomes, according to a study from a retina clinic in Northern California.

The study, published as a research letter in JAMA Ophthalmology, evaluated the effect of funding cuts to the Good Days program, which provided financial assistance to people receiving intravitreal injections of name-brand drugs for conditions such as age-related macular degeneration (AMD). The study included 110 patients, of whom 82 had received the assistance for their intravitreal injections of VEGF drugs but then lost the support after the organization closed its program for vascular and neovascular retinal disease due to a lack of funding.

“The study demonstrated a significant disruption to usual practice patterns,” William M. Carrera, MD, MS, a retina specialist at East Bay Retina Consultants, Inc., told Medscape Medical News. “The majority of our patients lost copayment assistance, and we transitioned most patients who lost funding to off-label bevacizumab,” a cancer drug repackaged by compounding pharmacies for ophthalmic use and which costs a fraction of the on-label retina medications.

Medicare reimbursed $68 for an injection dose of bevacizumab and $1831 for aflibercept, according to 2022 data. Drugs.com quotes an injection of ranibizumab at $1150-$1912. (Those figures do not include the procedures themselves.)

The End of Good Days

Clorinda Walley, the CEO of Good Days, said the demand for assistance from the copay assistance program is outpacing available funding. “We remain committed to securing additional funding to reopen the program as soon as possible,” she said.

A study last year of 280,000 treated eyes in a national electronic health records database, presented at the American Society of Retina Specialists (ASRS) 2025 Annual Meeting, found people in low-income zip codes had been disproportionately affected by the lack of assistance. Carrera’s study looked at how the cuts to Good Days affected patients from the clinician and patient perspective, he said.

Among the 82 patients who lost Good Days assistance, 50 (61%) switched from a branded anti-VEGF drug to bevacizumab, while the remaining 32 (39%) continued with their original biologic agent either through secondary insurance, paying out-of-pocket or by receiving repeated samples.

Overall, the study found no difference in vision outcomes between the patients who switched to bevacizumab and those who continued on their brand biologic, but the median interval between injections was 7 weeks in the switched group and 10 weeks in the other patients (P < .001).

“Notably, there was a small subset of patients that did not tolerate the transition to bevacizumab and had persistent fluid after switching,” Carrera said. Three of those patients (6.1%) had persistent retinal fluid, a sign of worsening disease, and switched back to their previous biologic.

“These patients either became dependent on samples or faced higher out-of-pocket expenses to maintain access to on-label therapy,” he said. “Costs among the patients who chose to cover their copayments out-of-pocket averaged $1139 over a 6-month period, which is a substantial expense for most patients. The results raise questions about whether these out-of-pocket expenses are sustainable and if this could lead to higher rates of later switching as the financial burden on patients increases.”

Carrera said longer-term studies would be needed to evaluate the effect of the payment support.

Patients who lost assistance also had to go to the office more often for injections, Carrera said: a median of 3.5-4 visits in the 6 months before the funding loss vs 4.5-6 visits in the 6 months after defunding. The researchers also observed a trend toward increasing central subretinal fluid, a biomarker of worsening disease, in patients switched to bevacizumab, but the difference was not statistically significant, he added.

The study complemented the larger study reported at the retinal meeting, Carrera said. “Our study was able to provide additional granularity regarding optical coherence tomography anatomic outcomes, as well as patient costs, which were substantial over the first six months after losing copayment assistance,” he said.

“Good Days defunding was the largest disruption to everyday treatment of AMD that we have encountered in recent years,” Carrera said. “Our findings suggest that retina specialists can find strategies for achieving comparable clinical outcomes but at a cost, including off-label treatment, more frequent visits and higher expenses for patients.”

The defunding of the Good Days program posed “a major challenge” to the retina community, said Christina Weng, MD, MBA, a retina specialist and researcher at Baylor College of Medicine’s Cullen Eye Institute in Houston. “The loss of funding for copayment assistance for patients with chronic retinal diseases threatens the visual well-being of thousands of Americans and may worsen socioeconomic disparities in ophthalmic care,” she said.

Weng noted the new study addressed the switch from a branded agent to off-label bevacizumab, not the use of bevacizumab as a first-line and ongoing therapy. But she also cautioned against finding reassurance that loss of copayment assistance did not harm patient outcomes.

“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,” Weng said.

Adding to uncertainty over copayment assistance funding, the FDA is considering the application for an ophthalmic, branded formulation of bevacizumab. “If this occurs, whether or not compounded bevacizumab, which will presumably be less costly, would still be available is unclear, making the state of copayment assistance funding an even greater concern,” Weng said.

Carrera reported serving as a consultant to Genentech. Weng reported having financial relationships with Genentech and Regeneron and being an executive committee member of ASRS.

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.