What's new is that the researchers are pushing for consideration of off-label use, and are proposing and incentive that would sweeten the deal for doctors doing so. Researchers note that doctors currently have little incentive to prescribe Avastin, because their reimbursement rate is based on the medication's price. Therefore, prescribing the $2,023-per-dose Lucentis is financially more rewarding than prescribing $55-per-dose Avastin. Their suggestion: pay doctors the Lucentis incentive for Avastin prescriptions. By their calculations, if this reimbursement converted 8% of Lucentis prescriptions into Avastin prescriptions, CMS's financial position would stay the same. Over 8% conversion would tip the system into savings mode.
Researchers also note that changing Lucentis prescriptions to Avastin prescriptions would ease patient financial pain, noting that retirees lacking supplemental insurance and dependent up on the average Social Security benefit end up spending at least 30% of their monthly stipend to cover Lucentis treatments “compared to less than 1 percent with use of [Avastin]." (Más)
The biologic drugs bevacizumab and ranibizumab have revolutionized treatment of diabetic macular edema and neovascular age-related macular degeneration, leading causes of blindness. Ophthalmologic use of these drugs has increased and now accounts for roughly one-sixth of the Medicare Part B drug budget. The two drugs have similar efficacy and potentially minor differences in adverse-event rates; however, at $2,023 per dose, ranibizumab costs forty times more than bevacizumab. Using modeling methods, we predict ten-year (2010–20) population-level costs and health benefits of using bevacizumab and ranibizumab. Our results show that
Altering patterns of use with these therapies by encouraging bevacizumab use and hastening approval of biosimilar therapies would dramatically reduce spending without substantially affecting patient outcomes. (Ver)