We must reduce drug costs to curb Medicare spending
As a senior retina surgeon in practice for 38 years, I need to respond to the April 10 News article titled, “Where the Medicare millions go.” Ophthalmology has one of the highest percentages of elderly patients among medical specialties. Common and expensive ophthalmic diseases occur in this age group, including cataract, diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, etc.
AMD is a leading cause of legal blindness in people over age 60 in the Western world. More than 3 million people experience visual loss due to AMD, a figure that may triple by the year 2020. For wet AMD, a more severe form, the treatment is the use of intravitreal injections. We are able to prevent legal blindness on a lot of these patients with very good results. The three commonly used drugs are Lucentis, Eylea and Avastin. The cost of either Lucentis or Eylea is approximately $2,000 per injection. Medicare pays 80 percent of the drug costs, which the doctor pays back to the drug company. The doctor does not make any money on these drugs. On the contrary, if the patient or the patient’s secondary insurance does not pay the doctor, a loss results.
Medicare reimbursement to the doctors can be very misleading. According to Dr. David W. Parke II, CEO of the American Academy of Ophthalmology, “Transparency is important, but drawing clinical conclusions from this particular data set is anything but transparent and easy.” The doctors should weigh the cost of the expensive drugs and their cost effectiveness versus the use of more reasonably priced drugs. The drug company can cut down the Medicare expense by lowering the cost of the expensive drug.
Faruk M. Koreishi, M.D., F.A.C.S.