Why Doctors Pick $2K Drug Over Its $50 Cousin

Pricey Lucentis, cheaper Avastin 'same damn molecule': ophthalmologist

By Matt Cantor,  Newser Staff

Posted Dec 9, 2013 7:26 AM CST

(Newser) – The prescription drugs Avastin and Lucentis both fight blindness in the elderly, and they're both made by the same company, Genentech, at what experts say is a similar production cost. The key difference between them: While an Avastin injection costs $50, a shot of Lucentis goes for $2,000. And more than half a million times per year, doctors opt for Lucentis, running up an extra $1 billion tab for Medicare, the Washington Post reports. Genentech generates a far bigger profit from Lucentis, and it "continues to maintain that Lucentis is the most appropriate medicine" for "wet age-related macular degeneration," saying it costs "significantly" more than Avastin to make. But doctors can also see a financial benefit from providing Lucentis, since Medicare rules reimburse them for the drug plus 6% of its price tacked on top. Genentech also gives doctors rebates when they use large amounts of Lucentis.

Some physicians, however, are railing against the process. "It’s the same damn molecule with a few cosmetic changes," says an opthalmologist fighting Lucentis. Thing is, Avastin was approved as a cancer drug, not an eye drug, and Genentech has shrugged off an FDA push to OK it for eyes. The result: Doctors prescribing it for the eyes are going "off-label." What's more, it's packaged in large quantities for use against cancer; the necessary repackaging by outside companies for use in the eye brings the threat of contamination. Still, doctors prescribe it 56% of the time, and six clinical trials have determined that the two are "largely equivalent," per the Post. Click for its full piece, which looks at the hurdles Medicare faces in obtaining better prices.

This file product image provided by Genentech shows a vial and package for the cancer drug Avastin.
This file product image provided by Genentech shows a vial and package for the cancer drug Avastin.   (AP Photo/Genentech, File)
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