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To: John McCarthy who wrote (209)	10/5/2009 7:00:43 PM
From: John McCarthy	Read Replies (1) \| Respond to of 421

How Cutting Payments for a Drug Could Cost Medicare More Medicare just started reimbursing doctors less for very small amounts of the cancer drug Avastin. Oddly enough, that could mean Medicare will start spending lots more money on the eye drug Lucentis. Here’s why. Lucentis and Avastin are very similar molecules. A few years back, before Lucentis was on the market, eye doctors realized that they could inject Avastin in patients’ eyes to treat macular degeneration, a condition that can lead to significant loss of vision and occurs mostly in the elderly. Avastin costs tens of thousands of dollars to treat cancer patients, but the tiny dose doctors inject into patients’ eyes costs a very small fraction of that –the specialty pharmacy chain The Apothecary Shops repackages Avastin for use in the eye and sells it to doctors for $27 per dose, John Musil, the company’s CEO, told the Health Blog. This week, Medicare cut its reimbursement for the dose of Avastin commonly used in the eye to about $7. Previously, when there was no specific billing code for tiny doses of Avastin, doctors could get reimbursed about $50 for using the drug in the eye, Philip Rosenfeld, an eye doctor at the University of Miami, told the Health Blog. For a dose of Lucentis, Medicare reimburses doctors $2,039. Doctors pay just under $2,000 for a dose of Lucentis, Rosenfeld said. That means that eye doctors will now lose a bit of money when they use Avastin to treat patients’ eyes, and make a bit of money when they use Lucentis. Avastin hasn’t been approved for use in the eye, but it’s legal for doctors to use it in that way. Many eye doctors use both Avastin and Lucentis, depending on patient preference, Rosenfeld said. Rosenfeld, like many docs, believes both drugs work equally well to treat macular degeneration; the NIH is currently sponsoring a head-to-head trial. But the new payment structure could push eye docs away from Avastin and toward the far more expensive Lucentis. “Doctors will do what’s in the best interest of the patients,” Rosenfeld said. “Given that both drugs are equal, it’s not surprising that they’ll do what’s in their financial interest.” That could mean a hit for Medicare, as well as for Medicare patients who are on the hook for co-pays. Both Lucentis and Avastin were developed by Genentech, now owned by Roche. U.S. sales of Lucentis were over $550 million in the first half of this year, Roche reported. Because the drug is primarily used by the elderly, much of that is paid for by Medicare. Until now, there was no specific Medicare billing code for small doses of Avastin. A Medicare spokeswoman said the new reimbursement level is based on a formula that is determined by law, and doesn’t take into account the costs of repackaging the drug. Photo: iStockphoto blogs.wsj.com

To: John McCarthy who wrote (209)	10/5/2009 7:16:56 PM
From: John McCarthy	Respond to of 421

Vital treatment to save eyesight denied A PHOTOGRAPHER from St Veep claims the NHS is risking her eyesight by denying her an effective treatment which would cure her rare condition. Emma Wiehahn suffers from a form of macular degeneration, which causes a loss of central vision due to the blood vessels behind the eye swelling and bursting causing scarring in the most sensitive part of the eye. Drugs do exist which experts say are successful in treating the condition – but the NHS has refused to pay for Emma's treatment. Emma, 48, said: "I woke up on a Monday morning in March with some unnatural blurry vision in my right eye. I saw a doctor who diagnosed me with the condition and said early treatment is vital. "I paid for one treatment of Avastin, which was like a miracle drug. I told the PCT about the success I experienced after being administered the drug and that I run a photography business, with my husband, and my eye sight is obviously vital. But apparently this doesn't mean anything to them. Elderly people are much more likely to suffer with the condition, and they do get the treatment they need. But I'm not – it's really frustrating." Emma wants the treatment now as she has been told the condition could spread to her left eye. "I woke up one morning unexpectedly suffering with the condition in my right eye," she said. "I'm just fearful of waking to find my left eye has the same problem. I urge the PCT to help me now." The drugs – Lucentis, which costs about £900 a dose, or Avastin, which costs less than £100 – are injected behind the eye to stop the vessels from swelling. However, Cornwall and Isles of Scilly Primary Care Trust (PCT) does fund for some people to be treated by these drugs but won't pay for Emma's. She is just one of around 1,200 people in the whole of the UK which suffer with this rare condition. But they do have the support of the charity Macular Disease Society which exists to help patients who suffer with macular degeneration. The charity's chief executive, Tom Bremridge, said: "We believe in the NHS. It is a great institution but the Department of Health allows 152 individual PCTs in England to impose their own rationing of treatment, flagrantly ignoring medical opinion." Steve Moore, the director of commissioning with NHS Cornwall and Isles of Scilly said: "We fund all treatments approved in NICE technology appraisals including those for age related macular degeneration and we have recently brought this service back into Cornwall to provide better local access. "We consider requests to fund non NICE approved treatments through an exceptional treatment panel on which clinicians are in the majority. "Requests to fund exceptional treatments should be made before the treatment happens. We are happy to consider further reques thisiscornwall.co.uk