OBJECTIVES: Anti-VEGF therapy with ranibizumab (RBZ) dosed monthly improves visual acuity over time in patients with neovascular (“wet”) age-related macular degeneration (wAMD).  In two identical phase 3 trials, IAI dosed 2mg every 2 months, following 3 initial monthly doses (2Q8) demonstrated clinically equivalent efficacy and a similar safety profile to RBZ 0.5mg dosed monthly (RQ4). We assessed the budgetary impact of adding IAI 2Q8 to a formulary of a hypothetical one million member US health plan.    METHODS: A Markov model characterized treatment with IAI 2Q8 and RQ4 over time. Health states were based on visual acuity in the better-seeing eye. Efficacy and cost estimates came from clinical trial data and published literature.  The model calculated direct medical costs, including costs of drug, administration, monitoring, visual impairment, and adverse events. Ten percent of patients were assumed to be treated in both eyes. We calculated  budgetary impact by comparing estimated costs over three years from current (100% RBZ market share) through future scenarios (IAI  market share: Year 1, 22%; Year 2, 42% ; Year 3, 51%). Model outcomes include total costs over three years in current and future scenarios, net costs, and cost per-member per-month (PMPM).   RESULTS: In a one million member plan, 2,800 were newly treated for wAMD. Total budget was $79.2 million in Year 1, $147.9 million in Year 2 and $152.4 million in Year 3 in the current scenario, and $71.9 million, $126.5, and $121.2 million in Years 1, 2 and 3 in the future scenario. Net budget impact ranged from  $-7.3 million in Year 1 to $-31.2 million in Year 3, or $0.61, $1.78, and $2.60 PMPM savings in Years 1, 2, and 3. CONCLUSIONS:  Adding IAI 2Q8 to a US formulary saves money in the first three years, primarily due to reduced injection frequency compared to RQ4.