InvestigationThe Billion-Dollar Eye Care Industry
Published February 2026 · 15 min read
Key Finding
Eye care is one of Medicare's costliest categories. Aflibercept (J0178) alone accounts for $19.7B — the single most expensive drug in Medicare. Combined with cataracts, eye exams, and retinal procedures, the top 20 eye care codes total $73.2B.
Ophthalmology is the second-largest Medicare specialty by total payments, with$66.3B in cumulative spending across 172.7K providers. Only Internal Medicine, with nearly a million providers, receives more.
What makes eye care unique is its combination of extremely expensive drugs, high-volume surgical procedures, and a patient population that virtually guarantees demand: nearly every Medicare beneficiary will need eye care at some point, and conditions like cataracts, macular degeneration, and glaucoma are age-related inevitabilities.
Aflibercept: The $19.7 Billion Drug
The most expensive single item in all of Medicare isn't a surgery, a hospital stay, or a piece of equipment — it's an injection. Aflibercept (brand name Eylea), billed under code J0178, has cost Medicare $19.7B over 10 years across 26.8M injections.
At an average of $741.00 per injection, aflibercept treats wet age-related macular degeneration (AMD) and diabetic macular edema — conditions that can cause blindness if untreated. Patients typically need injections every 4–8 weeks, often indefinitely, making it a recurring cost that compounds over time.
The Retinal Drug Trifecta
Aflibercept (Eylea)
$19.7B
26.8M injections · $741.00/each
Ranibizumab (Lucentis)
$7.8B
28.4M injections · $270.00/each
Faricimab (Vabysmo)
$1.1B
37.4M injections · Launched 2022
Combined retinal drug spending: $28.6B
Cataracts: The $16.3 Billion Surgery
Cataract removal (code 66984) is the most commonly performed surgery in Medicare, with 74.2M procedures over the analysis period — roughly 7.4 million per year. At $16.3B in total payments, it's the sixth most expensive code in the entire Medicare system.
The average cataract surgery costs Medicare about $350.00 — remarkably affordable for a procedure that restores vision. But the sheer volume makes it one of Medicare's largest line items. When you add complex cataracts (66982,$1.4B) and YAG laser capsulotomy for secondary cataracts (66821,$1.9B), the total cataract-related spend exceeds $19.7B.
The Complete Eye Care Spending Picture
Why Eye Care Costs Are Exploding
Several factors converge to make eye care one of Medicare's fastest-growing cost centers:
1. Demographics Are Destiny
The baby boomer generation is now squarely in the age range for cataracts (65+) and macular degeneration (75+). As this cohort ages, demand for eye procedures will only increase.
2. Expensive Biologics Replaced Cheap Alternatives
Before aflibercept and ranibizumab, many ophthalmologists used off-label bevacizumab (Avastin) — equally effective but costing ~$50 per injection vs. $741 for aflibercept. Market forces and FDA approvals shifted utilization toward the more expensive options.
3. Chronic Treatment Models
Retinal injections are not one-time treatments — patients need repeated injections for years or decades. A single AMD patient may receive 50+ injections at $741.00 each, costing Medicare over $37.0K per patient.
4. New Technologies, New Costs
Faricimab (Vabysmo), launched in 2022, already generated $1.1B in two years. Premium IOLs, minimally invasive glaucoma surgeries, and advanced retinal imaging add new cost layers to eye care.
Eye Care Spending Breakdown
$44.4B
Surgeries & diagnostics
$66.3B
Total ophthalmology specialty
The Bevacizumab Question
The most controversial aspect of retinal drug spending is the underuse of bevacizumab (Avastin). Multiple large clinical trials — including the NIH-funded CATT trial — have shown bevacizumab to be clinically equivalent to ranibizumab for wet AMD treatment, at roughly 1/40th the cost.
If all aflibercept and ranibizumab injections had been replaced with bevacizumab, Medicare could have saved an estimated $25.0B over the analysis period. The reasons this hasn't happened include: bevacizumab isn't FDA-approved for eye use (it's a cancer drug used off-label), it requires compounding pharmacy preparation, and ophthalmologists receive higher reimbursement for administering more expensive drugs under Medicare's "buy and bill" system.
Why This Matters
Eye care spending illustrates a central tension in Medicare: between providing effective treatments and controlling costs. Aflibercept genuinely prevents blindness. Cataract surgery genuinely restores vision. These are among Medicare's most successful investments in quality of life.
But the scale — $73.2B for just the top 20 codes — demands scrutiny. When cheaper alternatives exist and market incentives push toward more expensive options, taxpayers bear the cost. With the aging population ensuring growing demand, the eye care spending trajectory will only steepen without policy intervention.
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