TABLE 3.

Payer Best Practices in Wet AMD Suggested by AMCP Market Insights Panel

Facilitate timely access to appropriate treatment	Timeliness and access to appropriate treatment are critical to achieving the best outcomes in wet AMD. They can be facilitated by ensuring the process for prior authorization of treatment is as efficient as possible. This could be through gold carding, for example, or not requiring authorization of the first treatment injection.
Gather multistakeholder input	Having a holistic view of wet AMD and its challenges is a significant element of coverage and care-related decision-making. Regular communication to gather input from multiple stakeholders, such as retinal specialists and patients or their representatives, can assist in achieving this.
Embrace appropriate new technologies	Processes for embracing appropriate new technologies related to wet AMD are important. This includes new medication technologies (eg, gene therapy) and other technologies that have the potential to impact the condition in the future as they continue to evolve (eg, telemedicine and artificial intelligence).
Consider value-based agreements	These could be based, for example, on improvement or maintenance of BCVA or visual field. If a proportion of the membership does not achieve the outcome criteria after a specified length of treatment, the cost of the product or the difference in claim costs for switching would be reimbursed to the payer.
Encourage screening and advocate for incorporation into quality measures	Early screening and diagnosis assist with timely treatment and high-quality outcomes; however, currently, formal quality measures for eye health screenings (eg, HEDIS measures, Star ratings) exist only for patients with diabetes. Encouraging regular screenings and advocating for an age-related eye health quality measure are steps payers can take to ensure high-quality patient care.

AMD = age-related macular degeneration; BCVA = best-corrected visual acuity; HEDIS = Healthcare Effectiveness Data and Information Set; VEGF = vascular endothelial growth factor.