Behind ophthalmology's recent ranking as Medicare's highest-reimbursed specialty is a tale of two eye drugs.
Lucentis and Avastin have been shown equally effective in combating age-related macular degeneration, the leading cause of blindness in the elderly. They share a similar molecular make-up and even the same manufacturer.
But the cost per dose is much different: $2,000 versus $50. With a recommended two-year, 24-injection course of treatment, the difference per patient is huge.
Ophthalmologists, who buy the drugs and are then reimbursed for them, used the pricier Lucentis often enough to account for about $1 billion in Medicare spending in 2012, according to recently released data from Centers for Medicare and Medicaid Services. Indeed, Lucentis is a key reason ophthalmologists are at the top of the Medicare list.
Critics say the way doctors are reimbursed under Medicare — the average cost of the drug, plus 6 percent of the cost — sets up a financial incentive to choose the costlier medication. An Ohio ophthalmologist who has been outspoken on the debate, Dr. J. Gregory Rosenthal, said doctors shouldn't use Lucentis.
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Lucentis and Avastin have been shown equally effective in combating age-related macular degeneration, the leading cause of blindness in the elderly. They share a similar molecular make-up and even the same manufacturer.
But the cost per dose is much different: $2,000 versus $50. With a recommended two-year, 24-injection course of treatment, the difference per patient is huge.
Ophthalmologists, who buy the drugs and are then reimbursed for them, used the pricier Lucentis often enough to account for about $1 billion in Medicare spending in 2012, according to recently released data from Centers for Medicare and Medicaid Services. Indeed, Lucentis is a key reason ophthalmologists are at the top of the Medicare list.
Critics say the way doctors are reimbursed under Medicare — the average cost of the drug, plus 6 percent of the cost — sets up a financial incentive to choose the costlier medication. An Ohio ophthalmologist who has been outspoken on the debate, Dr. J. Gregory Rosenthal, said doctors shouldn't use Lucentis.
continue to read here
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