It’s hard to believe that about 20 years ago, the anti-VEGF revolution caught fire with the rapid adoption of off-label intravitreal bevacizumab. As a fellow, I remember the excitement of seeing the dramatic response for the first time ever in wet age-related macular degeneration. Despite the passage of time, bevacizumab continues to be widely used and commonly mandated by insurances with step therapy.

On July 24, 2026, Outlook Therapeutics announced the FDA-approval of bevacizumab-vikg (Lytenava) for the treatment of wet AMD. On one hand, we now have an on-label formulation of bevacizumab that has been specifically vetted for intravitreal use. On the other hand, there are major concerns about how this will impact access to compounded bevacizumab and costs for patients, practices and the overall health-care system.

With an FDA-approved version, will compounding pharmacies be prohibited from repackaging our usual bevacizumab (Avastin, Genentech)? My guess is no, at least not in the near term.

First off, bevacizumab-vikg is only approved for wet AMD so we still need a source of bevacizumab for other retinal vascular disease indications. Secondly, there is no direct precedent where the FDA has shut down compounding in a similar situation. When there was a shortage of GLP-1 drugs, the FDA initially permitted pharmacies to compound the medication from its bulk components. Once the shortage was over, they essentially instructed pharmacies that they should no longer be producing the drug. However, in the case of bevacizumab, compounding pharmacies aren’t trying to recreate the reference product but are simply repackaging it. 

The one issue that could be a threat to compounding pharmacies is that if a significant part of their business decreases due to a large portion of wet AMD patients migrating to bevacizumab-vikg, the per-syringe cost of compounded bevacizumab could go up due to decreased demand and poorer economies of scale, leading to a cycle of even less practice incentive to purchase it and further rising repackaged drug cost.

What about cost and how this will impact our patients and practice? It’s possible that commercial insurers may begin to require bevacizumab-vikg instead of the compounded version, especially if it’s priced competitively in relationship to the other FDA-approved alternatives. In the United Kingdom, the per-dose cost is around $600. Similarly, if reimbursement is favorable for practices from both commercial insurers and Medicare without being more onerous for patients, then physicians may be more likely to choose it. If these conditions aren’t met, I imagine the speed of adoption may be much slower.

Regardless, it will be interesting to see how bevacizumab-vikg is incorporated into our ever-growing armamentarium of treatments for retinal disease. RS