Healthcare Hullabaloo: Pirate Latitudes

Avast thar me maties! Thar be treasure to be plundered!

Actually, I meant AVASTIN, And it’s patients who are to be plundered.

Mea culpa. Let me explain.

Avastin is a powerful anti-cancer drug that’s manufactured by pharm-giant Genentech. It is used to combat several forms of cancer by preventing the growth of new blood vessels, a common phenomena in cancerous tumors.

Some forward thinking ophthalmologists (eye doctors for you heathens) had a very bright idea about using this wonder drug. You see, ophthalmologists treat a terrible disease called macular degeneration (or AMD), which robs the sight of thousands and thousands of (usually older) patients every year. In the US alone, about 200,000 new case of AMD are diagnosed each year, and, left untreated, lead to a gradual loss of vision. The thing about Macular Degeneration is that it is caused by the rapid growth of new blood vessels inside the eye. If Avastin works on cancer tumors by restricting new blood vessel growth, couldn’t it also be used to combat AMD?

Turns out, it could. A minute amount of Avastin, injected directly into the eye, actually proved to stop (and in some cases reverse) AMD, thereby saving the sight of hundreds of thousands of Americans every year.

Except that Avastin has several problems.

First and foremost, Avastin for ophthalmologic use is only needed in very tiny doses – perhaps only one-hundredth of the amount used to treat cancer patients.

Secondly, Avastin is not FDA approved for ophthalmologic use. It only comes in the large, economy size that is sold to oncologists (cancer doctors, you heathens). In fact, for ophthalmologists, it was almost like they were buying the drug at Costco – they got a great price, but it was far too much for them to use.

So, these bright eye docs bought the Costco-sized packages of Avastin and sent them to compounding pharmacies – special pharmacies that take the jumbo, Super Big Gulp sized packages of Avastin and split them down into the tiny dosages used by the eye doctors treating AMD.

The third problem of Avastin – the real turd in the punchbowl – is that it has competition – a new drug called Lucentis. Lucentis is an extremely similar drug to Avastin. They are almost identical, chemically speaking, and for good reason – both drugs were developed and are marketed by pharma-giant Genentech. Unlike Avastin, however, Lucentis is FDA approved for ophthalmologic use. It comes in the handy small doses that ophthalmologists need to treat AMD. And, most importantly, this almost-identical drug costs around 10 times the per dose price of Avastin.

Poor Genentech. What’s a money-grabbing pharmaceutical giant to do???

Plenty. With this much money involved, Genentech released the hounds faster than Monty Burns. Citing ‘safety concerns’, they stopped selling and shipping Avastin to compounding pharmacies. Not that there has been one documented case of ill effects related to a compounding pharmacy, but that’s beside the point.

Not stopping there, Genentech convinced Medicare to cut reimbursement for Avastin injections by ophthalmologists. Since most AMD patients are on Medicare (and a fixed income), this was a brilliant move by Genentech. Ophthalmologists who were being reimbursed for Avastin at $50 an injection are now only paid a measly $7.00 per treatment – not a lot of money for sticking a needle in someone’s eyeball if you ask me.

For the Medicare patient, this strategy has helped level the playing field between the two competing drugs. Where Medicare patients used to pay a $15 copay for their Avastin treatment, they now pay a whopping $150 copay per dose, as opposed to an average copay of $400 for Lucentis.

For the fixed income Medicare patient with AMD, the new $150 copay may just prove too much of a burden to handle.

Faced with this economic dilemma, the cash-strapped senior may not know whether to shit or go blind.

Luckily for them, Genentech has helped make this decision for them – all in the name of corporate greed.

Thanks. Genentech executives. I sincerely hope that their seeing eye dogs piss on the leg of your Armani suits.

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