Policyholder Services

Does my policy cover me for the administration of intravitreal drugs for the treatment of macular degeneration?

Yes, intravitreal injections for the treatment of retinal diseases such as macular degeneration are covered under Surgery Class 3.

Intravitreal injections have been used for many years in the treatment of macular degeneration. Macugen (Pegaptanib), which obtained FDA approval in 2004, was the first drug approved as an intravitreal injection for the treatment of neovascular (wet) AMD. In 2006, Lucentis (ranibizumab) was approved, and Eylea (aflibercept or VEGF Trap-Eye) obtained FDA approval in November 2011. OMIC has developed sample consent forms for each of these treatment options.

Although Avastin (Bevacizumab) is not specifically approved by the FDA for treatment of AMD, many ophthalmologists have administered it on an off-label basis instead of using FDA-approved counterparts because of its significantly reduced cost to patients. Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) results published in 2011 confirm that Avastin is a safe, effective, and cost-effective treatment for neovascular AMD. However, as a result of compounding risks and reported cases of endophthalmitis following the injection of Avastin, questions have been raised whether it is appropriate to continue using this drug. The American Academy of Ophthalmology and specialty societies have convened to discuss this topic in further detail. In the meantime, physicians should use careful judgment to determine the best treatment option for each patient. OMIC’s risk management recommendations, which accompany the sample consent form OMIC has developed for the off-label, intravitreal use of Avastin, may assist physicians in this process.