Billions could be saved if one drug is chosen over another

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KANSAS CITY, Mo. — A new report finds Medicare, other health insurers and individuals could save billions of dollars if doctors prescribed one drug instead of another for a blinding disease.

Avastin costs $55 a dose, and Lucentis costs $2,000. At that price, one would think Lucentis is much more effective, but surprisingly it’s not.

“They work in exactly the same way, and they have a very similar safety profile,” said Dr. Abraham Poulose, an ophthalmologist with Sabates Eye Centers.

Both drugs are injected into the eye to prevent blindness in people with the wet form of macular degeneration.  A new study in the journal Health Affairs finds if all eye doctors prescribed the cheaper Avastin, it would save Medicare and taxpayers $18 billion over 10 years.  It would save $4 billion in co-payments from patients’ wallets, and billions more in private health insurance payments.

So why instead is the more expensive drug being used?  In the case of Roger Donlon, a Congressional Medal of Honor recipient, it’s the drug he started with years ago.  He’s stuck with Lucentis because it has saved his sight.

“If you’ve got a winner, you stick with a winner,” said Donlon.

But Dr. Poulose says he now injects the cheaper Avastin in the vast majority of his patients.

“I see no reason to use Lucentis as a first-line drug when you have a product that’s just as effective,” he said.

Other doctors may use Lucentis because it is FDA-approved for macular degeneration, and Avastin is not.  It’s a cancer drug.  Its maker, Genentech, has no incentive to get it FDA-approved for the eyes, mainly because that same company also makes Lucentis.

Another possible reason doctors are prescribing Lucentis?  They are paid more by Medicare for injecting it since the payment is based on the drug’s cost.

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