OBJECTIVES: Traditionally, treatments for orphan conditions have faced fewer pricing and reimbursement hurdles by managed care organizations in the United States.  Given the downward pressure on healthcare spending and anticipated full implementation of the Affordable Care Act, we sought to better understand whether payer perspectives were evolving to more restrictive coverage and downward pricing pressure for treatments of orphan conditions like posterior non-infectious uveitis. METHODS: We conducted 20 in-depth, qualitative, 60-minute interviews with key decision-makers (medical and pharmacy directors) at managed care organizations in the United States.  Interviews included questions related to current orphan drug policy, awareness of posterior non-infectious uveitis (orphan condition), opinions on a treatment for posterior non-infectious uveitis currently under development, and potential pricing and reimbursement based on anticipated clinical trial endpoints. RESULTS: Of the 20 medical and pharmacy directors interviewed as part of this research, 10 (50%) felt that orphan treatment coverage policies will evolve independent of future healthcare changes due to the full implementation of the Affordable Care Act.  When asked to consider factors that impact coverage policies for a novel orphan treatment for posterior non-infectious uveitis, 14 (70%) felt that the clinical effectiveness and clinical utility of the product is the most important factor for coverage, though budget impact may increase coverage specifications. CONCLUSIONS: The evolving payer landscape due to the implementation of ACA indicated increasing levels of scrutiny about coverage of orphan drugs, but payers interviewed for this research felt that treatments of posterior non-infectious uveitis will be covered, though the budget impact of treatment may increase utilization management at the pharmacy level.