Anti-VEGF
The durability inflection, in claims.
From high-frequency Eylea and off-label Avastin to durable Vabysmo and Eylea HD — here's what IMX Data sees in U.S. retinal-injection claims.
Press arrow keys, space, or Enter to advance
VEGF — vascular endothelial growth factor — is the protein that fuels the abnormal, leaky retinal blood vessels behind the leading causes of vision loss in older adults; anti-VEGF drugs, injected into the eye, block it and are the standard of care. IMX assigns every anti-VEGF patient a single primary indication from the retinal diagnoses on their medical claims — the 2025 cohort shown here runs wet age-related macular degeneration (AMD) first, then diabetic disease, then retinal vein occlusion.
IMX claims show U.S. anti-VEGF injections grew +690% from 0.3M (2015) to 2.4M (2025), tracking 0.57M unique patients.
Durable next-gen agents (Vabysmo, Eylea HD) and aflibercept biosimilars have climbed from ~2% of injections in 2022 to ~33% in 2025 — taking share from legacy Eylea, Lucentis, and off-label Avastin, injection-by-injection.
The signal: a market that ran on legacy Eylea, Lucentis, and off-label Avastin for a decade is re-rating fast — durable next-gen agents and cheap biosimilars are taking share on both flanks at once, and IMX catches which agent is winning month by month, injection by injection.
IMX records every billed charge on every anti-VEGF medical claim — from $0.8B in 2015 to $7.2B in 2025 (+788%). These are submitted amounts on the medical claim, directional but not net-of-rebate. Avastin (off-label) is bevacizumab — an FDA-approved cancer drug not indicated for the eye, but compounded into low-cost intravitreal doses and used off-label for retinal disease (hence its low line despite high volume).
The signal: These are real charges from actual medical claims, not a modeled estimate — so the trends they trace (the trajectory, the agent mix, the biosimilar inflection) are representative of the real-world market.
Regeneron = Eylea 2mg + Eylea HD. Roche / Genentech = Vabysmo + Lucentis + Susvimo. Other / Off-label = Avastin (off-label bevacizumab), Beovu, and biosimilars. Billed charges are submitted amounts on IMX medical claims — directional; not net of rebates.
Off-label Avastin leads by volume (~37%) but trails badly by dollars — see the volume-vs-revenue slide. Next-gen = the durable agents Vabysmo (faricimab) and Eylea HD (8 mg aflibercept). Chart shows the six core agents covered in this analysis; aflibercept and ranibizumab biosimilars are tracked and appear in subsequent slides.
IMX captures U.S. physician-administered drug claims at the depth financial analysis needs — by HCPCS agent, indication, site of care, payer, injector, and geography. Anti-VEGF agents are identified by their J-/Q-codes in the procedure_code field on medical claims.
Eylea, Eylea HD, Vabysmo, Lucentis, Beovu, Susvimo, off-label Avastin, and aflibercept/ranibizumab biosimilars — each identified by its HCPCS code, deduplicated to injection events.
Office vs. hospital-outpatient mix and billed-charge differentials — the data behind the 2026 CMS site-of-care payment shift.
Injecting-physician specialty mix and primary retinal indication (wet AMD, DME/diabetic retinopathy, RVO) for every treated patient.
Real-world injections per eye per year — the metric that tests whether next-gen agents actually extend treatment intervals outside the trial setting.
Eylea HD and Vabysmo gained while legacy Eylea 2mg gave ground as biosimilars entered. And IMX moves with the real world: wherever a manufacturer reported revenue rising or falling, IMX billed charges moved the same direction.
Billed charges by agent · FY2024 vs. FY2025 · IMX Data
| Agent | FY2024 | FY2025 | IMX YoY | Real-World Rev. |
|---|---|---|---|---|
| Eylea (2mg) | $3.76B | $2.72B | -28% | ↓ Down |
| Vabysmo | $1.97B | $2.38B | +21% | ↑ Up |
| Eylea HD (8mg) | $0.71B | $1.15B | +63% | ↑ Up |
| Lucentis | $0.21B | $0.17B | -21% | ↓ Down |
| Beovu (brolucizumab) | $0.02B | $0.01B | -29% | ↓ Down |
FY2024/FY2025 columns are IMX billed charges (submitted amount, gross — not net of rebates). 'Real-World Rev.' is the direction only (not magnitude) of manufacturer-reported revenue FY2024→FY2025 — Regeneron U.S. filings (Eylea 2mg, Eylea HD) and Roche/Novartis filings (Vabysmo, Lucentis, Beovu; global where U.S. isn't broken out). Direction matches IMX in every case shown.
The dashed line marks Eylea HD's launch (Aug 2023). From its 2022 peak, Eylea 2mg volume has fallen 35% — sliding month over month as Regeneron migrates patients onto higher-dose, longer-interval Eylea HD (and, from 2025, as aflibercept biosimilars pile on). Eylea HD now makes up 23% of the aflibercept franchise.
The signal: The migration is the story: as Eylea HD ramps from its 2023 launch, Eylea 2mg is rolling over — down 35% from its peak. 2mg is still the bigger seller, but Regeneron is steadily shifting the franchise to the higher-dose agent, and IMX captures the switch month by month.
Vabysmo now rivals the legacy leaders, with Eylea HD and — from 2025 — aflibercept biosimilars climbing fast behind it.
The signal: The biosimilar wave has a pecking order that likely follows the parent molecule: aflibercept biosimilars ramp because Eylea is the market's dominant molecule, while ranibizumab biosimilars fell 66% in 2025 as the older Lucentis molecule fades — cheap-biosimilar demand consolidating on the stronger franchise.
Solid = IMX real-world most-common (mode) interval in whole weeks — robust to discontinue-then-restart lapses without any cutoff; dotted lines = Eylea's FDA-label interval, which varies by indication — monthly (~4 wk) for RVO and loading, up to every 8 weeks for wet AMD / DME / DR maintenance (wet AMD and Eylea HD extend further). Per-patient, all-time; later dose numbers partly reflect recent-starter censoring. Label sources: Eylea 2mg, Eylea HD.
The signal: Two different rhythms: regular Eylea holds tight — ~5-week first doses easing to ~6 — while Eylea HD front-loads monthly (~4 wk) then stretches to ~8, the interval extension that justifies the higher-dose franchise. IMX shows the real-world cadence, dose by dose.
Anti-VEGF is a quick in-office injection — done at the slit lamp in minutes, no operating room or facility needed — so practices keep it in-house. Office share rose from 90% in 2015 to 97% in 2025, while facility settings stayed essentially flat.
The signal: Because ~97% of anti-VEGF injections happen in physician offices, the 2026 CMS site-of-care payment changes land squarely on the office channel — exactly where IMX has the volume.
Every standard agent — Avastin, Eylea, Vabysmo, biosimilars — is a quick in-office injection (~96–99% office). Susvimo is the lone exception: it's an implant that has to be surgically placed in an operating room, so it skews to facilities (refills are still in-office).
Why it matters: a pipeline of implants and gene therapies would pull volume toward facilities — a shift IMX can track agent-by-agent.
Anti-VEGF treats diseases of aging eyes — wet AMD and diabetic retinopathy concentrate in the 75+ population, a largely retired cohort. That shapes who pays: ~60% of injections bill to Medicare, with commercial a distant second.
The signal: the age curve explains the payer mix — an elderly, wet-AMD-heavy population is old enough for Medicare, so the class bills overwhelmingly to it, making Part B and the 2026 CMS changes its dominant access lever. Payment type from the medical claim (Medicare Advantage vs. fee-for-service is not separable); birth year is top-coded, so the oldest patients fold into the 75–84 band.
Ophthalmology and retina specialists account for the overwhelming majority of anti-VEGF volume. Through 2024, a stable base of ~4,409 injectors delivered ~501 injections each — one of the most concentrated drug-administration footprints in medicine.
The signal: Because ~93% of anti-VEGF volume runs through retina and ophthalmology specialists, the entire class is reachable through a narrow, well-defined prescriber base — one IMX can target and track down to the individual injector (NPI).
The top 5 states account for ~38% of all U.S. anti-VEGF injection volume.
Off-label Avastin is ~37% of injections but only ~3% of billed charges — because it's cancer-drug bevacizumab, compounded from a single vial into many tiny intravitreal doses that bill a fraction of a branded biologic. Branded Eylea and Vabysmo are the mirror image: roughly a quarter of the volume apiece, but the bulk of the dollars (Eylea alone ~38% of charges) at thousands per dose. Counts and dollars tell opposite stories.
The franchise math: the aflibercept franchise (Eylea + Eylea HD) and Vabysmo carry the dollars; Avastin carries the volume. Biosimilar entry compresses the branded-dollar pool exactly where the charges are concentrated.
IMX measures U.S. units administered — the drug units billed on each claim, not raw injection counts; Regeneron reports U.S. net sales. Regress one on the other, year over year, and the fit is tight — IMX explains the direction of the reported dollars, with a steady net-price headwind on top.
IMX units-administered YoY vs. Regeneron-reported U.S. net-sales YoY · Eylea 2mg (J0178) · reported = public 10-K filings, external benchmark (not an IMX figure).
R² is the share of the year-to-year variation in reported revenue that IMX unit growth explains — here ~97%, i.e. nearly all of it (R² of 1.0 = a perfect fit).
The signal: across 2020–2025, IMX unit growth tracks almost all of the year-over-year movement in Regeneron's reported U.S. Eylea revenue — the points fall right on the line. At flat volume, reported dollars still erode ~5%/yr, the standing net-price drag from biosimilars and Eylea HD. IMX gives you the volume signal in real time; the rest is price.
The through-line: volume keeps climbing because patient growth outruns interval extension — IMX unique patients rose ~+7%/yr (2019–2025) while injections per patient eased ~1.6%/yr, netting the +5.6%/yr that carries the projection to ~3.2M by 2030 (solid = IMX actuals, dashed = IMX-derived projection). The watch-item: if durable agents push per-patient frequency down faster than new patients arrive, that net could flatten toward a plateau.
IMX Data delivers the claim-level depth behind the durability inflection.
Every agent · Every site of care · Every injection.