Jim Kenney, RPh, MBA: Dr Sheth, can you describe generically how has access to treatments changed over the past few years, and are there any initiatives you could suggest or ideas to expand access? Has it gotten worse, has it gotten better? It sounds like there have [been] more steps put in place, so maybe that’s not a great thing, but maybe you could describe how has access changed over the past few years.

Veeral Sheth, MD, MBA, FACS, FASRS: I think the other members of the panel will agree that overall access has not gotten any better. I think that it is narrowing more and more. There are more hoops to jump through. Things like these prior authorizations and these extra steps that we have to go through in order to get medications for our patients, it’s not only a burden for the patient, but it’s a burden for the staff, adding layers of cost and time and inefficiencies into the system. Generically speaking, I think that’s what we’ve seen as a pattern over the last few years. I think the anxiety that’s building up in a lot of us is, we’ve got newer treatments on the horizon. We’ve got biosimilars and potentially newer agents coming out. The question is, how are those going to be incorporated? What extra hoops are we going to have to jump through? Are there going to be multiple step edits? Because ultimately, that to me translates to worse outcomes for our patients. I think that’s why the anxiety in me is building with these newer treatments coming out.

To your second part of that question, what do we do about it? How do we expand access or improve some of these things? I think what we’re doing right now is important. Having these conversations, educating all the stakeholders involved is very important. To Caesar’s point, I think payers understand, everyone wants what’s best for these patients. Points like well, at year 3 they’re getting fewer injections, but there’s turnover. But there is turnover in both directions; you’re going to get these patients, you’re going to lose some of these patients. I think ultimately we do have to play the long game with some of these things. I know it’s hard to do when we’re looking at fiscal years and budgets and things like that. But at the end of the day, I think if we look at the long run for these patients, fewer injections over time, better visual outcomes, so less burden on society, and keeping people active and working and all of those things is going to be critical to making sure these things play out well.

Transcript edited for clarity.