New national scorecard exposes insurance coverage disparities for vision-threatening disease treatments

The scorecard thus highlighted the fact that millions of American patients face barriers to accessing life-changing treatments based on their health plan. Image credit: AdobeStock/RonAlvey

Let My Doctors Decide Action Network’s (LMDD AN) new national scorecard has exposed disparities in insurance coverage for serious and rare eye diseases.¹ The LMDD Eye Health Scorecard specifically evaluated insurance coverage for treatments addressing geographic atrophy (GA), neovascular age-related macular degeneration (AMD), and thyroid eye disease, according to a news release.

The scorecard thus highlighted the fact that millions of American patients face barriers to accessing life-changing treatments based on their health plan.¹

“Despite medical advancements, many patients are still trapped in a system where access depends on the luck of their insurance card,” said Brett McReynolds, policy advisor for LMDD AN, in the release. “We urge policymakers, insurers, and healthcare leaders to break down these harmful, unnecessary barriers and prioritize patient health over administrative red tape.”

Some of the findings from the scorecard include Medicaid plans having the greatest restrictions and Medicare plans having the fewest access restrictions overall. Approximately 70% of state Medicaid plans received an “F” grade across all condition assessed. Access for patients with Managed Medicaid plans was slightly better, even though a majority of plans received a “C” or “F” score for their coverage of all conditions included. Additionally, traditional Medicare received an “A” grade for nearly 100% of its plans for all conditions where treatments were administered under the medical benefit. Even with more restrictions imposed in the Medicare Advantage plans, a majority of said plans received either “A” or “B” grades for all conditions.¹

Other findings from the scorecard revealed a significant variation in coverage and access by disease condition and plan type, and about half of Commercial, Health Exchange, and Medicaid plans received either “C” or “D” grades. On average, beneficiaries of Commercial, Health Exchange, and Medicaid plans experience at least 2 access restrictions on average.¹

The scorecard underscored that most patients experience restrictive insurance policies, including authorization, onerous step therapy, and high cost-sharing, which can delay or limit access to prescribed treatments.¹

“For patients battling serious and rare eye conditions, timely access to treatment isn’t a luxury—it’s a lifeline to prevent permanent and irreversible vision loss,” said Molly Murray, president and CEO of the Autoimmune Association, in the release. “The results expose a healthcare system that is failing to meet its most fundamental promise: providing care when and where it’s needed.”

The scorecard was compiled by analyzing thousands of private, Medicare, and Medicaid health plans across the US and was developed in partnership with health care research firm MMIT, which provided data for the scorecard. The evaluation focused on US Food and Drug Administration approved treatments for the 4 conditions and assessed coverage under both medical benefit and pharmacy benefit, or drugs administered in a doctor’s office and medications dispensed through a pharmacy. Plans were given a numeric score of 0-4, with higher scores reflecting larger barriers to access based on the presence of step therapy, prior authorization, and/or placement on a plan’s specialty tier. Those numerical scores were then converted into letter grades.¹

“Without adequate and timely insurance coverage, patients living with debilitating, rare eye diseases face devastating, life-altering consequences—not just loss of vision, but also loss of independence, employment, and quality of life,” said Jeff Todd, president and CEO of Prevent Blindness, in the release. “The LMDD Eye Health Scorecard findings underscore the urgent need for policy and regulatory reforms to ensure equitable access to sight-saving treatments, with limited barriers between diagnosis and treatment delivery.”

Reference:

1. New eye health scorecard reveals gaps in treatment across insurance plans. News release. Let My Doctors Decide Action Network. May 22, 2025. Accessed May 22, 2025.