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Medicare coverage of PDT for macular degeneration to expand
Medicare will widen its coverage of photodynamic therapy to include more patients with age-related macular degeneration, it was announced last week.
The Centers for Medicare and Medicaid Services has agreed to reimburse physicians for the use of Visudyne (verteporfin for injection, Novartis) to treat some patients with subfoveal occult with no classic choroidal neovascularization (CNV) and subfoveal minimally classic CNV associated with AMD, according to a press release from the comarketers of the drug, Novartis and QLT.
The press release noted that reimbursement will cover lesions that are four disc areas or less in size and that have shown recent disease progression. Medicare already covers PDT in AMD for patients with predominantly classic lesions.
Paul Hastings, chief executive officer of QLT, said in a Reuters report that the new rules would make between 40,000 and 60,000 more patients with AMD eligible for reimbursement.
The CMS decision to cover the other forms of AMD comes after a recommendation in support of the expansion by the Medicare Coverage Advisory Committee in September. According to a press release from the American Academy of Ophthalmology, which lobbied in favor of the expansion, the additional coverage is unlikely to be implemented before July 1.
Outside the United States, Visudyne is commercially available in more than 70 countries for the treatment of predominantly classic subfoveal CNV and in more than 40 countries for occult subfoveal CNV caused by AMD, according to the press release. It is also approved in numerous countries for the treatment of subfoveal CNV from pathologic myopia.
After the announcement of the CMS plans for additional reimbursement, market analysts revised their sales expectations for the drug, according to the Reuters report. Visudyne is now expected to generate sales of $538 million, up from earlier estimates of $461 million. Shares of QLT rose nearly 30% on January 29 in reaction to the news, Reuters reported.