Supply Chain Volatility of Repackaged Intravitreal Bevacizumab: A Survey of the American Society of Retina Specialists

Purpose: To characterize retina specialists’ perceptions of the intravitreal (IVT) bevacizumab supply chain after the manufacturer, Pine Pharmaceuticals, announced they would no longer produce the formulation. Methods: A 22-question survey was created to assess retina physicians’ use of IVT bevacizumab, perceptions of the supply chain, and how the decision will affect patient care. The survey was electronically distributed to all members of the American Society of Retina Specialists. Results: The survey was completed by 287 retina specialists. In the 3 months before the survey, 194 (67.6%) physicians reported receiving IVT bevacizumab from Pine Pharmaceuticals. Approximately 85% of physicians were either very concerned (158 [55.4%]) or concerned (85 [29.8%]) about their access to the medication in the next 3 months. Most physicians anticipated needing to delay or change patient appointments (142 [50.4%]) or change patient treatment plans (179 [63.9%]) because of shortages of IVT bevacizumab. Respondents overwhelmingly believed that patients with step-therapy requirements were most likely to be affected by appointment delays (119 [83.8%]) and changes in treatment plans (140 [78.2%]). Conclusions: The majority of retina specialists surveyed expect the decision to halt production of IVT bevacizumab will significantly disrupt access to the medication and adversely affect patient care. Most physicians predict delays and changes in treatment, particularly for patients with IVT bevacizumab step-therapy requirements. Therefore, to minimize negative effects on patient care, we recommend that carriers suspend step-therapy requirements, especially given that the disruption to the supply chain is likely to be longstanding.