Retina practices enter 2026 facing greater complexity - and greater need for strategic support

Lessons from a pivotal year
2025 underscored shifting dynamics in retina products and biosimilars, creating both opportunity and volatility. Practices faced more frequent product evaluation cycles as average sales price (ASP) trends made it difficult for practices to maintain consistent margins on drug administration. Coverage policies tightened across payers, and step edits and payer-imposed therapy pathways became more common. For Medicare patients, the lack of out-of-pocket (OOP) assistance added further strain, especially for those relying on high-cost treatments for conditions like macular degeneration. 

Administrative pressure also intensified with more paperwork, prior authorizations, and regulatory hoops. Many physicians had to adjust treatment sequencing – sometimes having to try lower-cost therapies first or delaying care while approvals caught up. These shifts added stress for staff and increased operational costs for practices and patients alike.

One theme stood out: operational agility mattered. Practices that coordinated across clinical teams, billing, and procurement were better positioned to adapt. In some markets, practices even leaned on one another, forming regional alliances to respond more consistently to payer behavior.

Top concerns for retina in 2026
Insights from Cencora customer surveys and subject matter experts pointed to several priorities shaping the year ahead: 

• Funding instability. Practices expect continued volatility in patient funding due to economic uncertainty and payer behavior. The unpredictability of available support programs remains a major concern. 
• Escalation of “fail-first” protocols or payer step therapy and step edits. With more biosimilars entering the retina space, payer positioning battles are likely to intensify. Practices anticipate more forced therapy changes, delayed treatment success, and heavier administrative workloads – all of which increase the need for coordinated regional responses.
• Physician recruitment. Workforce shortages continue to shape long-term planning, particularly as demand for retina services grows. 

Cencora anticipates several market dynamics that could amplify these pressures. Multiple retina biosimilar launches are expected in the second half of 2026, echoing trends seen in oncology and rheumatology. Practices that borrow best practices from those specialties – patient education, transparent financial discussions, and clear communication around interchangeability – will be better prepared. 

Payer pressure is also expected to intensify. Stricter step therapy protocols for anti-VEGF therapies used to treat age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) will increase both financial and administrative strain. Retina practices will also face increased administrative burden from payers, meaning more prior authorization requests, denials, and appeals that they will need to carefully navigate to reduce financial risks to both the practice overall and patients.

Financial decision-making will become increasingly complex as ASP movement affects purchasing strategies, inventory risk, scheduling, and revenue cycle outcomes.

Across the board, practices are turning to peers, consultants, and solution partners like Cencora for clarity and direction.

Navigating therapy decisions in a volatile environment
Rapid product introductions and ASP fluctuations are creating uncertainty for practices trying to maintain both clinical stability and financial sustainability. Practices tell us they are growing frustrated with frequent pivots in therapy utilization in response by evolving value propositions. When a therapy decision changes, it can affect the entire care plan for a patient – even small ASP movements can cascade into scheduling changes, inventory exposure, and patient communication hurdles. 

While Cencora does not influence clinical decision-making or payer contracting, we can help practices make sense of the broader market forces shaping these decisions. Our team supports practices by: 

• Interpreting macro-level trends, including how biosimilar introductions typically influence ASP curves over time. 
• Sharing insights from oncology and rheumatology, where providers have already navigated similar waves of biosimilar disruption. 
• Highlighting tools, decision frameworks, and operational approaches that other practices have used successfully to manage volatility. 
• Providing education and market context that helps practices anticipate shifts in reimbursement, utilization, and payer behavior. 

This type of support gives practices a clearer line of sight into what may be coming, helping to plan inventory, staffing, and patient communication strategies with greater confidence.

How Cencora is supporting retina practices 
Across conversations, one theme is consistent: practices want a trusted source of market intelligence to help them stay ahead of change. Cencora has been providing strategic support to the retina market for nearly 20 years and is well-positioned to play that role by offering timely insights, cross-specialty learnings, and operational guidance that supports both patient continuity and financial stability.   

Whether a solo physician just starting out or a long-standing multi-physician group, retina practices are working  in an environment where access, economics, and day-to-day execution are tightly linked. Cencora’s integrated model - spanning distribution, GPO, and specialty solutions – was built with that reality in mind. Our goal is to help improve treatment access and affordability while giving practices the clarity they need to navigate a shifting market.

Through coordinated support and consistent, practice-relevant insights, Cencora helps reduce administrative burden and strengthen operational confidence. Throughout 2026, we will continue to provide retina practices with solutions and resources they need to adapt: technology, services, market-focused articles, podcasts and expert discussions, reimbursement education, and opportunities for consultative or educational collaboration.   We are committed to meeting practices where they are and equip them with the information and support necessary to be successful and provide optimal patient care.   

Looking ahead 
The retina market will only grow more complex – but complexity also creates opportunity. Practices that plan proactively, stay informed, and build operational flexibility will be best positioned to navigate payer pressure, reimbursement variability, and biosimilar-driven shifts while protecting continuity of care.