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October 12, 2009

Avastin vs Lucentis: Why our Gov't Will Never Manage Healthcare Efficiently!

There have been several articles in the New York Times discussing how the current health care proposals currently being debated will do little to control health care costs.  In my opinion government control of health care and health care cost control are mutually exclusive!  A case in point:  the Avastin vs Lucentis controversy.

I have previously discussed the Avastin vs Lucentis controversy in this blog.  Basically, there are 2 medications used to treat certain types of macular degeneration: 

  • Avastin, a cancer medication, is used as an of label use to treat macular degeneration at a cost of about $50 per injection
  • Lucentis, approved for the treatment of macular degeneration at a cost of about $2000 per injection

These drugs need to be used every 2 to 3 months to control macular degeneration.  Both drugs are made by a Roche subsidiary, Genentech.  In my opinion, both drugs are equally efficacious in the treatment.  In the past a doctor could make more money by using the more expensive Lucentis, as the law allows a percentage mark up on injectables.

The New York Times reported on October 1 a change in the Medicare rule concerning these medications.  Medicare will continue to fully reimburse the doctor who uses the $2000 Lucentis , but will only reimburse the doctor $7.20 for using Avastin, which costs the doctor $50!  So now there is a double incentive for using the $2000 treatment every few months:

  1. Ability to make more money ( a percentage of the more expensive medication)
  2. Using the less expensive medication will cost the treating doc $42.80 out of his own pocket.

Do the math, with over 1.7 million people suffering from macular degeneration, this myopic policy will cost the tax payer hundreds of millions of dollars annually.  It will also cost the patients an additional $400 per treatment, the 20% that Medicare does not cover.

In the past I have stopped referring my patients to retinal surgeons who use Lucentis before Avastin.  Now, with this change in policy, I can't blame them for not wanting to "pay" to treat these patients!

What I do know is that our health care system is a mess.  I don't trust the Democrats, I don't trust the Republicans, I don't trust Obama, and I don't trust the insurance industry!  Who do you trust??

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