Eylea Market Share 2x more Than Lucentis in WMD and 3x more in DME/DR based on Medicare Claims Analysis


In Eylea

By: Avinash Kumar  Apr. 08, 2019

Dexur’s analysis of medicare claims shows that Eylea (Aflibercept) is being used twice as much as Lucentis (Ranibizumab) for Wet Age-related Macular Degeneration (Wet AMD) and three times as much for Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR) causes. The claims analysis was from Jan 2016 to June 2018 based on a 5% sample of all Medicare patients. The claims analysis looked at the J Code usage of Aflibercept (J0178) & Ranibizumab (J2778).

Dexur’s methodology evaluated the primary diagnosis codes of all usage of the drug and categorized into the main categories of usage such as Wet Age-related Macular Degeneration (Wet AMD), Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR) & Retinal Vein Occlusion (RVO) and Macular Edema following RVO.

A representative list of ICD codes to the mapped categories is given below.

Wet Age-related Macular Degeneration (Wet AMD)Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR)Retinal Vein Occlusion (RVO) and Macular Edema following RVO
  1. Exudative age-related macular degeneration
  2. Exudative age-related macular degeneration, right eye, with active choroidal neovascularization 
  3. Exudative age-related macular degeneration, left eye, with active choroidal neovascularization 
  4. Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization
  1. Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
  2. Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral 
  3. Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema 
  4. Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
  1. Tributary (branch) retinal vein occlusion, left eye, with macular edema
  2. Tributary (branch) retinal vein occlusion, right eye, with macular edema 
  3. Central retinal vein occlusion, right eye, with macular edema
  4. Central retinal vein occlusion, left eye, with macular edema

Dexur’s analysis also showed a wide variation of Eylea & Lucentis usage based on the specific Diagnosis code. For e.g. Eylea had a much higher share in severe cases with ICD codes such as “Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral” than other milder codes such as “Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral”.

DEXUR PRO MEMBERS:

Dexur Pro members get Claims Numbers and payments for each category - Wet Age-related Macular Degeneration (Wet AMD), Diabetic Macular Edema (DME) and Diabetic Retinopathy (DR), Retinal Vein Occlusion (RVO) and Macular Edema following RVO & others.

More detailed analysis at the ICD level and showing quarter over quarter analysis is also available for research subscribers. Email dexur@dexur.com for details on the Ophthalmology market and detailed claims level analysis for Eylea, Lucentis and other drugs.


ABOUT THE AUTHOR

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Avinash Kumar

Avinash Kumar is a Business analyst with over 9 years of healthcare experience. He has expertise in Real World Evidence (RWE), healthcare claims analytics, market research, data analytics, benefits configuration, claim contractual reprising, adjudication, implementation of reimbursement rule edits for healthcare payers and revenue cycle management for providers. Avinash holds a Master's degree in Operations management and life sciences. He is a certified medical coder from American Association of Professional Coders (AAPC).