Letter to the Editor

Whether doctors are wrongly prescribing drug is in eye of beholder

The Dec. 8 front-page article “Expensive drug costs Medicare billions” asserted that “Doctors and drugmakers profit when more-costly treatments are adopted,” and it reported that the eye drug Lucentis costs about 40 times more than Avastin to provide similar treatment. Three points:

First, ophthalmologists are currently reimbursed above the cost of Lucentis by 4 percent, not the 6 percent stated in the article. This $80 covers the costs of ordering and handling Lucentis, resulting in a typical net “profit” closer to $40.

Second, the largest association of ophthalmologists — my organization — was instrumental in securing Medicare coverage for Avastin. However, recently enacted regulations in some states require that each dose of Avastin be ordered from the compounder with a “patient-specific” prescription. This change requires the patient now to have two office visits instead of one and causes a delay in administering a vision-saving medication, an increase in hassle and cost that many patients are unwilling to assume. 

Finally, as noted in the article, as a compounded medication Avastin carries a small risk of infection from the compounding process. After a discussion of that risk, many patients elect not to be treated with Avastin, despite the physician’s willingness to do so.

David W. Parke II, San Francisco

The writer is chief executive of the American Academy of Ophthalmology.

 
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