Avedro announced a comprehensive effort to secure commercial coverage and support reimbursement of Photrexa Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa (riboflavin 5’- phosphate dextran ophthalmic solution) and the KXL System used in corneal cross-linking for the treatment of progressive keratoconus and corneal ectasia following refractive surgery. The company’s multi-faceted initiative will help improve patient access to medically necessary treatment for these sight-threatening orphan diseases.
“Avedro has heard from many patients and physicians that the current out-of-pocket payment structure is an impediment to patients getting treated with cross-linking,” Reza Zadno, Chief Executive Officer of Avedro, said in a company news release. “Avedro is committed to supporting patients who require cross-linking so that they have access to this procedure. We believe that insurance companies will recognize the benefits of cross-linking, and we look forward to working with patients and physician practices to navigate this process, while increasing access to care.”
The initiative encompasses several components, including the launch of the Avedro Reimbursement Customer Hub (ARCH) Program. Starting June 15, the ARCH Program will offer:
1. A Reimbursement Support Service, including a hotline for questions and resources to assist with the commercial payer appeals process
2. A Patient Assistance Program that supports financially eligible, uninsured patients by providing Photrexa Viscous and Photrexa at no charge
3. A Prescription Assistance Program, which minimizes insured patients’ out-of-pocket expenses for Photrexa Viscous and Photrexa in cases of commercial insurance coverage denials
In addition, Avedro has established commercial pricing for Photrexa Viscous and Photrexa. The commercial pricing brings this one-time, medically necessary treatment to a level that is reflective of its significant clinical value.
“Keratoconus, when left untreated, can result in significant deterioration of vision, and may lead to multiple, costly corneal transplants, with the potential to adversely affect patients’ quality of life,” Rajesh Rajpal, MD, Chief Medical Officer for Avedro, said in a company news release. “We believe that working together with physicians, specialty societies and commercial payers, as well as with patients, will ultimately result in more patients having access to this medically necessary treatment.”
“Keratoconus patients face serious challenges with their disease, both clinically and financially,” said Mary Prudden, Program Director, National Keratoconus Foundation. “We know that the number one reason patients delay treatment is financial, often resulting from lack of insurance coverage. We are thrilled that Avedro is supporting the effort to drive insurance coverage for patients. The company’s advocacy and support programs will help reduce financial barriers to the treatment of keratoconus.”