Doctors Continue to Bill Medicare for $2000 Lucentis Instead of Prescribing $50 Avastin for Elderly Blindness

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In his 1999 stand-up special, comedian Chris Rock made an observation about the medical industry with respect to “curing” disease. “Ain’t no money in the cure,” he says in his typical half-shout, “the money is in the medicine. That’s how you get paid, on the comeback.” Like all good comedy, the joke has a basis in the truth, and that truth is that the pharmaceutical industry is not in the business of healing the sick, but instead is in the business of making as much money as possible.

The truth of the bit is evidenced by a recent controversy surrounding two products produced by Genetech (a division of the Roche Group) which puts out two medicines—Avastin and Lucentis—that stave off blindness from macular degeneration. While the two medicines are “cousins,” according to a report from The Washington Post, Lucentis is 40 times more expensive than Avastin and “[d]octors choose the more expensive drug more than half a million times every year.” The increased cost for Medicare patients alone is around $1 billion. Doctors prescribe this medicine because under the rules in Medicare, doctors are eligible to be reimbursed for the price of the medicine plus six percent.

Medical experts suggest that Genetech’s claim that Lucentis is “significantly” more costly to manufacture is simply not accurate. However in a report from the Irish Medical Times, a study “had shown that patients given Avastin had a 1.3-fold increased risk of serious systemic adverse events, when compared with those who got Lucentis.” Those pushing for the increased use of the cheaper drug suggest that overall the drugs are identical in effect and risk of side effect.

The main impediment to Avastin’s use is that it was not originally designed for eye treatments, and thus the FDA has not ruled it safe for such use despite, according to The Post, “encouragement from the FDA to seek official approval for using it to treat eye ailments.” Looking back at the last disease to be cured (according to Chris Rock, that is) polio, Forbes magazine estimates that Dr. Jonas Salk forfeited around $7 billion by not patenting the vaccine. Genetech however stands by their decision claiming safety concerns and filling their coffers with taxpayer money.