Using Genentech's Avastin off-label for macular degeneration, rather than the company's similar eye drug Lucentis, could have saved Medicare more than $1 billion over two years, the HHS inspector general found in an audit. Meanwhile, Medicare beneficiaries would have saved $275 million, the IG said. As it stands, Lucentis is the single-biggest expense in the pharma budget of Medicare Part B, which covers injectables and biologics, the Wall Street Journal reports.
The price difference between the two drugs--$2,000 per injection for Lucentis versus about $50 per eye-sized injection of Avastin--prompted the IG to call on Medicare to ask Congress for more power over pricing, at least with expensive biologics like Lucentis. Due to be released today, the report notes that the Centers for Medicare and Medicaid Services cannot currently force price concessions or rebates on drugmakers.
The IG's report follows pricing pressure from the Senate Special Committee on Aging, the WSJ notes, as well as medical associations and consumer groups. The Senate committee recently suggested Medicare conduct a national coverage review of Lucentis vs. Avastin, which could lead to broader use of the cheaper drug by eye doctors. But, "[a]ny action CMS takes to encourage the use of Avastin to treat wet AMD could be controversial," the IG noted in its report. And that's an understatement.
Complicating the issue is safety. To be used by ophthalmologists, Avastin must be repackaged into eye-sized doses. Genentech, now a divison of the Swiss drugmaker Roche, has long warned the repackaging, usually done by compounding pharmacists, opens Avastin to contamination.
And that's just what happened recently. The FDA reported a cluster of infections--some causing vision loss--in patients who'd received Avastin injections in their eyes. The agency didn't call for a halt on the off-label use, but warned that repackaging needed to be done with care to prevent contamination.
- read the WSJ report