Low-Income Patients Hit Hardest by Copay Program Underfunding | ASRS 2025

Copay assistance programs play an essential role for patients who receive treatment for retinal diseases. The underfunding of one such program, Good Days, has led to significant treatment disruptions, especially in low-income areas, according to two separate presentations at the American Society of Retina Specialists (ASRS) annual meeting being held in Long Beach, California.

For more than 20 years, Good Days, a nonprofit organization, has provided copay and financial assistance for patients facing financial challenges related to healthcare. But as of January 2025, funding for retina and macular disease treatment has been unreliable as costs have increased.

As a result of funding for copay and coinsurance, patients with wet age-related macular degeneration, diabetic macular edema and geographic atrophy have been more likely to forgo care. Patients switched to lower-cost alternatives, delayed treatment or skipped doses, and some stopped treatment entirely. This has led to patients experiencing a decline in their vision, speakers said.

Michael Lai, M.D., Ph.D.

“The underfunding of Good Days has caused widespread treatment disruption for Medicare-age patients with retinal diseases, particularly in low-income areas,” Michael Lai, M.D., Ph.D., of the Retina Group of Washington, said during the meeting. “Specialists reported growing dependence on less effective treatment alternatives, delays in care, complete discontinuation of therapy, and perhaps most disturbingly, patient harm in the form of vision loss. The study shows that copay assistance programs like Good Days play a critical role in access to retinal therapy and preservation of vision.”

Ghassan Ghorayeb, M.D.

“The message is clear: copay assistance is not a luxury, and restoring it is a political and economic imperative,” Ghassan Ghorayeb, M.D., of the West Virginia University Eye Institute, said during his presentation.

At least one pharmaceutical company has made a commitment to the Good Days organization. In June 2025, Regeneron Pharmaceuticals launched a matching program for donations to support the organization’s Retinal Vascular and Neovascular Disease Fund. Regeneron has committed to matching donations up to a total of $200 million for the remainder of 2025.

Regeneron markets Eylea (aflibercept) and Eylea HD (aflibercept). Aflibercept is an anti-vascular endothelial growth factor (VEGF), which reduces blood vessel leakage and growth. Eylea HD is approved for patients with wet AMD, macular edema, and diabetic retinopathy. The low-dose form of Eylea is also approved to treat patients with retinopathy of prematurity (ROP), wet AMD, macular edema, and diabetic retinopathy.

What the ASRS Studies Found

In his presentation, Lai presented the results of a survey of U.S. members of the American Society of Retina Specialists. Conducted in April 2025, the survey asked 455 retina specialists about how they have adapted to the funding gap and about their perceptions of patient outcomes.

More than 94% of the respondents reported a “significant” or “moderate” impact on their practice by Good Days’ underfunding. Seventy-eight percent noted that at least 25% of their Medicare-aged patients were unable to receive their preferred medications. About 93% switched to lower-cost alternatives, 60% delayed treatment, 41% skipped doses, 39% extended treatment intervals, and 26% stopped treatment entirely.

As a result, 61% of respondents observed vision loss among affected patients, and 63% reported loss to follow-up.

Switching to Avastin was the most common adaptation reported for patients with wet age-related macular degeneration (AMD) and diabetic macular edema (DME). Avastin (bevacizumab) is an oncology drug that is used off-label to treat these conditions and must be obtained from compounding pharmacies. These pharmacies repackage small quantities of bevacizumab into syringes for intravitreal injection.

In this survey, 77% of respondents said a disproportionate impact of Good Days’ underfunding impacted lower-income patients or underserved communities. Nearly twice as many patients in the lowest income ZIP Codes stopped treatment due to loss of Good Days’ financial support compared to patients in the highest income group.

Ghorayeb presented data from a real-world analysis that confirmed the findings of the ASRS survey. In this analysis, the electronic health records from 340 retina specialists in 68 private retina practices in the United States were studied. Data came from the Vestrum Health database, which provides reporting and analytics of retina EHR from Jan. 1, 2024, to June 8, 2025. Patients with neovascular age-related macular degeneration, diabetic macular edema and geographic atrophy were included, with more than 280,000 treated eyes.

Researchers found that among patients with neovascular AMD, the proportion receiving unsustainable care increased by 57.6% over the study period, rising from 7.1% to 11.2%. The percentage of patients switched from on-label therapies to repackaged Avastin rose 45.6%. Reliance on samples in anti-VEGF–non-naive eyes increased by 43.9%.

In patients with diabetic macular edema, unsustainable care patterns increased 32.6%, from 11.5% to 15.3%. The percentage of patients switched from on-label therapies to Avastin rose 36.9%. The number who received multiple samples in a single eye increased by 8.3%.

In the geographic atrophy population, unsustainable care patterns rose by 62.2%, increasing from 1.7% to 2.8%. During the same period, the number of patients receiving samples of products they had previously accessed through payments doubled.

Among patients who were switched from on-label therapies to Avastin and experienced visual decline, prevalence was 43.6% higher in lower-income regions than in higher-income ones.

“We saw significant and marked visual decline after these switches, and these seem to confirm the concerns highlighted in the ASRS survey,” Ghorayeb said during his presentation.