This is the Agency that is Going to Bend the Cost Curve?

Writing in the New York Times, Andrew Pollack reports that Medicare is about to stop paying for Avastin as a treatment for eye diseases. He writes, “But the way the bureaucratic gears mesh in this case, the move could end up costing Medicare itself hundreds of millions of dollars a year, and individual patients thousands of dollars.” Apparently there are two drugs used for macular degeneration, both made by Genentech, Lucentis that costs $2,000 per injection, and Avastin that costs $50 or less when used in the dose needed for eye disease. Medicare has decided to pay $7.50 per shot for Avastin but will continue to pay full price for Lucentis. Physicians would lose money on every dose of Avastin, but not on Lucentis.

According to Dr. David W. Parke II, chief executive of the American Academy of Ophthalmology, “about a million injections a year were given for macular degeneration, about half of them Avastin and the other half Lucentis.” Because patients pay 20% of the cost of the drug, both they and Medicare will have to pay a whole lot more to avoid going blind.

Comments (4)

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  1. Stephen C. says:

    Sounds like bureaucracy as usual.

  2. Larry C. says:

    I agree with Stephen.

  3. Devon Herrick says:

    I recall when doctors first figured out that Avastin could also be used for eye disease. The drug maker was concerned about how to price the drug when the dose for an eye was a small fraction of the dose for cancer. Drug makers generally like to keep the price of a given drug therapy similar regardless of dose. The drug maker shouldn’t have been concerned. Medicare will drive doctors to the higher-priced dose.

  4. Timothy O'Shea says:

    Some physicians chose to use Avastin in the eye despite the lack of large, prospective, well-controlled, randomized safety and efficacy studies (all of which exist for Lucentis). Rather than treating patients using level 1, evidence based medicine, the choice was made to use personal clinical experience and small case study series to justify using an unapproved (for ocular usage) colorectal cancer drug in the eyes of patients. This choice was made because Avastin could be aliquoted down into tiny, inexpensive doses which saved money for the patient, and was less expensive for the physician to stock. Now that some bizarre Medicare pronouncement has made it financially distasteful for physicians to inject Avastin (potentially decreasing revenue between 10 – 42 dollars for each injection than was previously realized), all of a sudden everyone is going to start injecting Lucentis?!? What happened to giving patients the best possible treatment? What happened to evidence-based medicine? Are we self-rationing care and looking for the cheapest way out already, even before the powers that be force us to do it?!? Shame on everyone making treatment decisions based on reimbursement rates and not data.