October 28, 2009WASHINGTON (AP) -- Medicare officials are backing off a policy that pushed many doctors to use a $2,000 injectable drug for a potentially blinding eye disorder, over a similar treatment that costs about $50.
The Centers for Medicare and Medicaid Services said late Tuesday it will reverse a decision from earlier this month that cut reimbursement for Avastin, a biotech drug from Genentech.
The payment change had the effect of forcing doctors to use a similar Genentech drug called Lucentis, which costs about $2,000 per injection.
Lucentis is formally approved for eye care, but it acts on the same biological protein as Avastin, which is approved as a cancer drug. For years, eye doctors have used tiny amounts of Avastin and billed the government for the cost, rather than purchasing Lucentis.
That practice largely stopped after an Oct. 1 change slashed Medicare reimbursement for Avastin to $7 from about $50, making it difficult to recoup the cost of the drug. Eye doctor groups complained the policy forced them to buy Lucentis instead, since the drug was still reimbursed at the full cost.
A spokesman for the Centers for Medicare and Medicaid Services said in a statement Tuesday evening that doctors will be able to resume billing for small doses of Avastin beginning in 2010.
Sen. Herb Kohl, D-Wis., praised the reversal Wednesday, saying it would save money for both the government and seniors.
"I'm pleased that CMS heeded the concerns of the medical eye care community and the aging committee," said Kohl, who chairs the Special Committee on Aging. "Even seniors who have insurance often cannot afford the high co-payments associated with Lucentis."
The co-payment for Lucentis averages $400 per injection, versus $9 for Avastin, according to the American Academy of Ophthalmologists.
An academy spokesman said Wednesday the group is "extremely pleased" with CMS' decision.
Kohl sent a letter to CMS earlier this month questioning the rationale behind the change. CMS runs the Medicare and Medicaid programs, which provide health care coverage to the elderly, poor and disabled.
A spokeswoman for South San Francisco-based Genentech said the company had no role in the decision to adjust the payment rate.
"Genentech believes that people should have access to the medicines their doctors feel are most appropriate for them," said Megan Pace.
The federal government spends about $1 billion a year on Lucentis, which is approved to treat wet, macular degeneration, a condition that causes blood vessels in the eye to leak fluid.
Genentech, a unit of Swiss firm Roche, says Lucentis is specially formulated with smaller molecules than Avastin to better penetrate the eye.
However, many eye doctors say there is no detectable difference in outcomes for patients. The American Academy of Ophthalmologists estimates about 60 percent of all injections for macular degeneration use Avastin.
Genentech has previously said Lucentis' price reflects the cost of developing the drug, which included a clinical trial involving more than 6,000 patients at a cost of more than $45,000 a patient.
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