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CMS to reverse ruling on bevacizumab reimbursement starting in 2010
The Centers for Medicare and Medicaid Services will reverse a ruling that would have reduced reimbursement rates for bevacizumab, according to a press release from the U.S. Senate's Special Committee on Aging.
In early October, CMS released a new code for Avastin (bevacizumab, Genentech) injections that would have lowered reimbursement to around $7.50 a dose. However, Sen. Herb Kohl, D-Wis., Chairman of the Special Committee on Aging, wrote to CMS, saying that the "scientific or regulatory reasons for this policy change are not readily apparent."
According to Sen. Kohl, Lucentis (ranibizumab, Genentech), another treatment for age-related macular degeneration, is priced about 20 times higher than the price of bevacizumab and is costing Medicare around $1 billion in reimbursement annually — a figure that could rise to $3 billion annually, according to CMS data. Necessitating the use of ranibizumab could end up costing seniors thousands of dollars in Medicare copayments, especially if multiple treatments are required, Sen. Kohl wrote in the letter.
According to the Special Committee on Aging, CMS will reverse the coding decision effective Jan. 1.
"I'm pleased that CMS heeded the concerns of the medical eye care community and the Aging Committee. Even seniors who have insurance often cannot afford the high copayments associated with Lucentis," Sen. Kohl said in the release. "Patients should have a choice between these drugs, both of which have been proven effective."