OBJECTIVES:  Age-related macular degeneration (AMD) is a chronic disease that can lead to blindness. The Brazilian public healthcare system (SUS) provides free of cost those drugs incorporated to its Pharmaceutical Assistance Program. The goal of this study is to determine the budget impact of aflibercept for SUS as compared with bevacizumab and ranibizumab. METHODS:  We have undertaken a budget impact analysis (BIA) following the Brazilian Ministry of Health (MOH) guidelines. The Brazilian population data was obtained from Instituto Brasileiro Geografia Estatística (IBGE) and epidemiological data from Brazilian Society of Retina and Vitreous (SBRV), with the prevalence of 10%. All drugs had their posology based on their Brazilian labels. The prices (ex-factory, maximum price for MOH, and negotiated prices) were from SUS. And other costs from SUS administrative databases, SIGTAP (for medical office, diagnosis tests and pharmaceutical application costs, etc.). We simulated various scenarios of diffusion rates from 10% to 70% penetration. RESULTS:  We have estimated that about 126,266 Brazilians are potential patients in the first year and 133,826 in the 5th year. The annual cost of treatment, using the maximum price for MOH, with aflibercept was R$ 20,809.81 (USD$ 6,120.00 ) for the first year, R$ 17,836.98 (USD$ 5,245.00) (from 2nd to 5th year); bevacizumab was R$ 15,536.64 (USD$ 4,519.00 ); and ranibizumab R$ 36,410.64 (USD$ 10,708.00). The total annual budget impact for SUS in the 10% scenarios was R$ 480 MI (USD$ 141 MI) for ranibizumab and R$280 MI (USD$ 82 MI) for aflibercept, considering that it was R$219MI (USD$ 64 MI) for bevacizumab. CONCLUSIONS:  Under the perspective of Brazilian SUS, ranibizumab had the higher costs, bevacizumab had similar efficacy with lowest costs, and aflibercept had also similar efficacy with intermediated costs between ranibizumab and bevacizumab. Thus, a strong price negotiation is recommended due to large budget impact on SUS.