How to Pay for Diabetic Macular Edema Medications

The costs of treating diabetic macular edema can be considerable, but you do have options.

The longer you have diabetes, the more likely you may be to develop diabetic retinopathy, a diabetes-related condition that affects your eyes.

Diabetic macular edema (DME) is a complication that can develop when high blood sugar levels damage the tiny blood vessels in the eye, causing fluid to leak into the part of the eye where your central vision occurs. The fluid causes swelling, which blurs your vision.

DME is on the rise, with nearly 537 million people worldwide estimated to have this retinal disorder in 2021, and experts predict that the number could surpass 783 million by 2045.

Without treatment, your vision is at risk, so you do have to consider the costs, including insurance coverage and out-of-pocket costs. Here’s what you need to know about paying for this important treatment.

The cost of treatment will vary, depending on the treatment your doctor suggests and how much your insurance plan will cover. Here are some possibilities to consider:

Your doctor may recommend anti-vascular endothelial growth factor (anti-VEGF) injections for several months with drugs such as:

• aflibercept
• ranibizumab
• bevacizumab
• faricimab
• brolucizumab

Experts generally consider anti-VEGF injections the most effective treatment for DME.

However, for some people, their DME often persists or even recurs after anti-VEGF injections. They need additional injections so they don’t lose more of their vision, according to 2023 research. That can drive the cost of treatment up.

The cost to you may ultimately depend on the specific type of treatment your doctor recommends and how you respond.

A review of claims data suggests that ranibizumab treatment costs about $3,500 to $4,500 less per year per person than treatment with aflibercept. This is because people did not need as many injections.

A 2024 study suggests that bevacizumab tends to cost less than ranibizumab or aflibercept because doctors use it off-label to treat DME.   

Another treatment option for some people with DME is an implant that delivers a corticosteroid into the eye. One example is the fluocinolone acetonide (FA) implant Iluvien, which costs about $7,770. Another example is the dexamethasone intravitreal implant Ozurdex. The estimated cost of one Ozurdex implant is about $1,400.

Your doctor might also suggest laser therapy. This entails using a laser to close off any leaking blood vessels in the eye or reduce or prevent the growth of new blood vessels that might also damage your eyesight. The cost of laser treatment may be less than some other types of treatment, such as aflibercept injections, but it rarely improves vision and mostly stabilizes vision loss.

In some cases, doctors can treat DME with surgery such as vitrectomy, which removes some or all of the gel-like vitreous in the eye.

While it’s not a first-line treatment, some 2023 research suggests that surgery has the potential to reduce progression and, therefore, vision loss.

The costs can also vary. For example, 2021 analysis found that a routine vitrectomy surgery cost about $7,170 per person, more than $2,000 beyond what Medicare would reimburse. However, your costs would depend on many factors, including your insurance, the facility, and even the type of anesthesia.

The first place to start is with your insurance coverage. Many insurance plans, including Medicare, do cover eye exams for people with diabetes and treatment for diabetic macular edema.

You may want to check with your insurance plan first to find out what’s covered and how much you’ll need to pay out of your own pocket.

For example, Medicare Part B covers a yearly eye exam for people with diabetes. However, Original Medicare will require you to meet the Part B deductible first and then pay an approved amount for the care.

You might also want to check with your insurance company to find out what copays are required. Some 2019 research found that people who have to pay a copay before getting treatment for DME are less likely to start treatment.

The costs of getting care for DME can vary. A 2023 study suggests the annual cost of DME for Medicare beneficiaries was about $4,700 in 2022. The cost for people with commercial insurance ranged from $3,600 to nearly $18,000.

It can be stressful to consider the treatment costs for a serious health condition like DME. If you’re worried about whether you can afford treatment, talk with your doctor. They can provide context about the costs of treatment options and help you figure out your next step.

You can also check out other resources that might be able to help you. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) maintains a list of potential resources to help with the costs of having diabetes.

In some cases, you may qualify for financial assistance from the manufacturer of a particular medication or treatment. Some manufacturers offer assistance or savings programs, like the savings program offered by the manufacturer of Ozurdex for people with commercial insurance. There is also a copay program for people with commercial or private insurance offered by the manufacturer of the Iluvien implant.

You can also check out copay assistance programs like the PAF Co-Pay Relief Program.

So, be sure to check out these options before deciding whether you can afford a particular treatment.

Treatment for DME can be costly and require multiple approaches. However, you can work with your doctor to find the right treatment and promote vision health.