After pressure from Congress and concern from doctors, the Centers for Medicare and Medicaid now plans to reverse recently enacted reimbursement coding for Avastin, which is used to treat wet macular degeneration, a leading cause of blindness among seniors and the elderly. The drug, you may recall, is often used off-label in small amounts to treat the eye disease.
Here's the rub: Avastin is made by Genentech, which also sells Lucentis, a much more expensive drug approved by the FDA to combat the same problem. But, as noted by Herb Kohl, a Wisconsin Democrat on the Senate Special Committee on Aging, anywhere from 50 percent to 60 percent of docs use Avastin instead of Lucentis. Why? Lucentis cost $2,000 a dose versus about $50 for Avastin.
Medicare recently introduced a new payment code that cut payments to docs - ophthalmologists and retinal surgeons - for small doses of Avastin, a move that could prompt them to switch to Lucentis. Kohl has been after CMS to reverse its coding (see his Oct. 9 letter here), because the higher-priced Lucentis may cost Medicare an extra $3 billion or so a year, and seniors may have to cough up additional copayments that he called "unaffordable." The CMS reversal takes effect on Jan. 1, The Wall Street Journal notes.
"Even seniors who have insurance often cannot afford the high co-payments associated with Lucentis,” Kohl says in a statement today. “Patients should have a choice between these drugs, both of which have been proven effective.”
6 Comments
Contrary to what Kohl says, both drugs have not been proven effective for AMD. There is no data on Avastin for AMD other than anecdotal, not a single comparative trial.
What Kohl is saying is that the FDA does not need to approve drugs nor CMS reimburse them based on evidence. They should do it on the whim of a congressman.
Whatever Paul, all of us use avastin and its actually better than Lucentis since it lasts longer. The Avastin vs. Lucentis trial has been sponsored by NEI since Genentech didnt want to do the trial. It will be out by 2011 and then people like you will get your data. For now, let us prevent blindness for a cheaper cost to our elderly population that cannot afford the copays of lucentis every month (around $400).
RetinaDoc is absolutely correct. The data is strong, and evidence based. The use of Avastin and Lucentis both lead to a 90-95% stabilization of vision and about a 40-50% increase in three lines of vision. Paul, my only fear for you is that you get ARMD and you refuse treatment. Know your facts first. Thank God, people like Kohl exist, and that companies like Genetech exist and dedicated surgeons like retinadoc exist. Thank God for miracle drugs like Avastin and Lucentis
Again, lots of anecdotal "evidence". I'll wait to see the data from the NEI study. If it shows Avastin is comparable or better, I'll concede in a flash. Until then, I can only rely on available evidence, which favors Lucentis.
Even if you believe what you're saying Paul, the data to which you refer would not "favor Lucentis," but rather would be agnostic on the issue of Lucentis vs Avastin.
And while it's certainly one thing to want to see NEI results, you ignore that there's a large span between anecdotal evidence and an NEI study -- a span that includes excellent, well-constructed peer-reviewed studies.
The data are there. Just because you want to close your eyes and stick your fingers in your ears doesn't make that untrue.
You cannot fault Paul for not having access to the data and coming up incorrect statements and conclusions.
Anyone here, as myself, who attended ASRS in NYC and last week at AAO Retina in SF will attest to the preliminary data not only showing efficacy but a a tend to a sustained effect of lesion remission with Avastin. In my own clinic we treat over 50 patients per week with both Lucentis and Avastin and both have shown excellent results since 2007. Our data has shown efficacy for over 2 years.