Avastin/Lucentis Update 30: A Followup to Update 26 – Sen. Herb Kohl Queries CMS

As reported by Alicia Mundy in a Wall Street Journal Health Blog yesterday evening, Senator Herb Kohl wants to know if Genentech had any input into the CMS decision to reduce the Medicare reimbursement rate for Avastin when used in small doses in the treatment for AMD.

Here is a copy of the WSJ blog and a link to Senator Kohl’s letter to CMS.


WSJ Health Blog
October 13, 2009, 5:41 PM ET

Senator Wants to Know About Medicare Shift on Eye Drugs
By Alicia Mundy

Sen. Herb Kohl wants to know whether Genentech was involved in a recent Medicare shift that could prompt eye doctors to use a more expensive drug. Genentech, which recently became part of Roche, says it wasn’t involved.

As we noted recently, Medicare introduced a new payment code that cut payments to doctors for small doses of Avastin, a cancer drug that many doctors use off-label to treat patients with macular degeneration. That could prompt doctors to switch to Lucentis, a similar but far more expensive drug approved for macular degeneration. (When used to treat the eye, Avastin costs less than $50 per dose; Lucentis costs about $2,000.)

Genentech had “no involvement” in the government’s decision to create a new payment code, a company spokeswoman told the Health Blog

Ophthalmologists are now using Avastin about as much as Lucentis, according to Dr. Philip Rosenfeld, a retina specialist in Florida. Both drugs are sold by Genentech, so its revenues would increase if eye doctors used less Avastin and more Lucentis. Rosenfeld, who was an early proponent of using Avastin in the eye, told us he thinks the change could cost the government nearly $500 million a year, based on estimates of usage he and other eye doctors have compiled.

In a recent letter to CMS, the agency that oversees Medicare, Kohl wrote that he was “disturbed to learn from members of the medical eye care community that Genentech may have communicated directly with CMS officials about this proposed coding change, reportedly suggesting that CMS was over-paying for the small amounts of Avastin being used off-label for intraocular treatments.”

Kohl wants all communication between Genentech and CMS on the matter. CMS says it is currently reviewing the letter and will respond to the senator.

Here is a link to Sen. Kohl’s letter.