Taxpayer-funded Medicare could save $18 billion over 10 years by using a less expensive drug to treat two common eye diseases, according to a team led by David Hutton, professor, of University of Michigan School of Public Health. Consumers could keep $4.6 billion in copays and the health care system could save $29 billion in private insurance payments and other costs by using bevacizumab (Avastin -$55/treatment) instead of ranibizumab (Lucentis – $2023/dose).
The Centers for Medicare and Medicaid Services released data in April 2014 showing that 17,000 ophthalmologists had some of the highest payment totals among all physicians. Ranibizumab — causing the largest percentage of reimbursements — is why.
Federal spending on the two drugs totaled $2 billion in 2010. That’s approximately one-sixth of the entire budged for Medicare Part B. Because injections happen during an office visit, these two medications aren’t covered by the prescription drug benefit, Part D.
Wet Form of Macular Degeneration or Diabetic Macular Edema
More than 2 million patients have these eye diseases. By 2020 nearly 3 million people will experience age-related macular degeneration.
Per NIH, ranibizumab can be injected in the eye every month because the drug can control wet macular degeneration, not cure it. It could be on a different schedule if the doctor prescribes.
“In two large clinical trials that have been done on use in eye disease, the data did not show a difference in rates of serious side effects, but those studies didn’t have enough power to fully address safety,” Hutton said.
The researchers want their analysis to capture the attention of health policymakers.
Hutton said, “I hope that this study raises awareness of the rest of the medical community, sheds light on the issue of the cost of biologic drugs, and brings attention to how long it takes to get biosimilars (generic versions) of these drugs approved.”
I can’t claim to know whether one drug is better than the other. Nor am I saying that any treatment should be determined by cost alone. I agree with Professor Hutton that we must take a closer look at the whole medication system to make it more efficient and cost effective. We should disregard political or business power mongers. Can I dream big, or what?
Call to Action Over Medication Costs
I will admit that drug cost is one of my hot buttons. I can only dream that people will revolt about reining in health care costs and become less concerned whether their unemployed, or underemployed, neighbor should have access to any health care. My very strong opinions follow.
- What can you do? People! Get out there and email your government representatives about pharmaceutical lobbyists. Also write them about Pharmacy Benefit Management (PBM) companies like Express Scripts. Sometimes these for-profit businesses use their buying power to drop older, less expensive, drugs off their formularies in deference to newer drugs. They make deals with pharmaceuticals for a larger slice of the pie with the more expensive, non-generic drugs. PBMs claim to negotiate with pharmaceuticals to drive down drug costs. But it sure looks like it benefits them a lot more than the consumer. This is why their formularies keep changing with no warning.
- Ask your representatives to create a law and vote in favor of allowing Medicare to negotiate drug prices for all of us. You and I will benefit.
- Get upset over drug companies “incentives” to doctors to use one medication over another. Talk to your doctors about using older medications that work just as well, sometimes better, than the brand-new ones they are encouraged to prescribe. Old does not mean it doesn’t work anymore.
- The debate regarding generics will never end, but consumers should have a choice. Even when drug patents are about to expire, pharmaceuticals tie up the production of generic drugs by patent stacking. “Some of them [new patents] are as frivolous as the color of the bottle,” says William Nixon of the Generic Pharmaceutical Association in Washington, D.C. “Every new patent that they can put through the patent and trademark office wins them another two-and-a-half year windfall at the expense of the consumer.” Add-on patents automatically delay the approval process of generics by the Food and Drug Administration.