Avastin and Medicare Compensation

Posted on blog: Because Avastin has yet to be approved for treatment of Macular Degeneration, Medicare will not pay for it.

--
Posted by Carrie to Age Related Macular Degeneration on 11/30/2005


Reply:

Avastin® has been FDA approved for the treatment of metastatic colon cancer. Physicians have the right to use an approved drug for any disease however, if they believe it will benefit their patient. For instance we inject drugs such as Kenalog®, antibiotics, and tissue plasminogen activator into the eye to treat various retinal diseases. None of these drugs was originally approved to treat ocular disease. In fact, intravitreal antibiotics are now the standard of care for treating endophthalmitis, and a physician could be sued if he/she didn’t use them in this non-approved fashion.
Medicare has recognized this and generally pays for both the drug and the injection. This is the case in Iowa where Medicare has been reimbursing us for both the Avastin® and the injection. It’s smart for them to do that because Visudyne® and Macugen® are more expensive than Avastin®.