The Washington Post examines how Lucentis, despite costing around $2,000, is not being edged out of the wet-AMD market by cheaper—as in $50—cancer drug Avastin. The newspaper says it comes down to marketing, physician incentive, and Genentech’s antipathy toward seeking a wet-AMD indication for Avastin.
The WaPo says payments are part of what appeals to physicians, because Medicare reimburses doctors based on a medication’s average price, plus 6%. This essentially front-loads the prescription-writing scenario, which continues to tilt in this direction because Medicare can’t push back, as cheaper Avastin is not indicated to treat this condition.
Although off-label use is not unheard of in the industry, the Washington Post reports Avastin’s packaging discourages ophthalmologists from using the cheaper medication which is intended for cancer patients, who require large doses. Whittling these prepackaged doses down to ophthalmologist-friendly sizes would require a third party opening the medication, which the WaPo notes can up the contamination risk. WaPo also notes that Genentech “reminded doctors that if the repackaging firms cutting Avastin into smaller doses were careless, infection could be introduced.”
WaPo notes that although Genentech says it spent $1.4 billion to develop Lucentis, it has sold $2.1 billion in the US and several billion more abroad through its partner Novartis, and reports that some scientists think Lucentis may in fact be cheaper to produce than Avastin.