Senator probes Medicare shift to Lucentis

Inquiring Senate minds are wondering why Medicare shut the door on payments for ophthalmologic use of the cancer drug Avastin. As you know, the government program will now pay only for Genentech's much pricier drug Lucentis to treat wet macular degeneration. Avastin, which eye docs have been using off-label for the same use, won't be reimbursed.

So Senator Herb Kohl is asking why. Did Genentech twist a few arms, he wonders? Genentech told the Wall Street Journal Health Blog that it didn't. But Kohl alleged in a letter to the Center for Medicare Services that he'd heard the company may have "communicated directly with CMS officials" about the coding change. "Members of the medical eye care community" told the senator that Genentech suggested CMS was overpaying for Avastin, the letter stated.

Eye doctors have been up in arms over their ability to use Avastin before. Genentech tried some time ago to limit distribution of the drug to compounding pharmacies that would repackage Avastin into eye-dose-sized containers. But the ophthalmologists fought back, and Genentech softened its stance. Whether the docs have insight into the CMS coding change--or are just suspiciously cooking up theories--remains to be seen. Kohl asked for all communication between the company and CMS on the change; let's see what he gets.

- read the Health Blog post

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