Lucentis Costing Medicare $1 Billion

An analysis of medicare data shows that Lucentis, a treatment for wet macular degeneration is costing Medicare in the United States approximately $1 Billion per year. Researchers and eye care specialists have indicated there are alternatives to Lucentis that can offer dramatic savings for the program.

In analysing the claims of more than 880,000 medical professionals, it was discovered that the most heavily reimbursed procedure, costing $1 billion for 143,000 patients was for the drug Lucentis. This drug is used to treat age related macular degeneration, an eye disease common in the elderly.

Thirty doctors in Massachusetts alone were paid more than $45 million in 2012.

What is surprising is that the drug Lucentis used to treat macular degeneration costs more than six times more than using an alternative drug, Avastin. However, Avastin is not approved for treating wet macular degeneration but Lucentis is. However, the process of off-label prescriptions allowing the use of Avastin is permitted for treating macular degeneration even though it is not FDA approved for treating the eye disease.

Avastin is a close cousin to Lucentis and has proven both effective and relatively safe for treating macular degeneration. An analsys of the usage shows that a patient would typically pay $50,000 per year to be treated with Lucentis, compared to just $650 for Avastin.