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Assume Avastin not covered by Medicare, ophthalmologist says
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NEW YORK — Retina specialists should assume that treatment of retinal diseases with the cancer drug bevacizumab will not be covered by Medicare, one physician speaking here said.
Avastin (bevacizumab, Genentech) is approved in the United States for the treatment of colorectal cancer. Genentech has another drug, Lucentis (ranibizumab), awaiting regulatory approval for the treatment of age-related macular degeneration. But recently there has been interest among retinal specialists in use of the already-approved drug in an off-label fashion as a systemic or intravitreal treatment for AMD.
“Avastin seems to work, there are no apparent adverse effects, and it’s inexpensive, so what’s the problem?” George A. Williams, MD, asked rhetorically here at Macula 2006. One problem, he said, is that Medicare and private insurance carriers are not reimbursing for the use of the drug for this indication.
Before administering the drug intravitreally for treatment of retinal disease, the physician should first give patients who are Medicare beneficiaries an Advance Beneficiary Notice informing them that the procedure will likely not be covered by Medicare, Dr. Williams said.
He said one reason Medicare may be unwilling to cover off-label use of Avastin is that it could set a precedent for off-label uses of other oncologic drugs.
In addition, Dr. Williams said he received an e-mail message from a medical director of an insurance carrier saying that the company would not cover Avastin for the treatment of age-related macular degeneration because it was considered investigational.
Furthermore, Dr. Williams said, the Health Insurance Portability and Accountability Act has created a new crime called health care fraud, and his closing message was, “Buyer beware.”