Will insurance cover $2K drug for diabetic eye disease?

Traditionally, patients suffering from diabetic macular edema have undergone laser treatments for their condition. A new study shows that patients benefit from receiving an injection of the drug Lucentis in combination with the laser therapy. Diabetic macular edema (DME) is the main cause of vision loss in people with diabetes. The new study, published in the current issue of Ophthalmology, reveals that 50% of patients who received Lucentis eye injections in conjunction with laser treatment, had markedly improved vision one year after treatment. In contrast, only 28 percent of patients who received just the laser treatment had improved vision after one year. The findings of the study will be reviewed by the American Academy of Ophthalmology (AAO), which will make recommendations on whether the combination therapy of Lucentis and laser treatments should be the preferred treatment for patients with DME. The study results are particularly interesting for two reasons. First, Lucentis is FDA approved only for the treatment of wet macular degeneration. So although it is commonly being used for that purpose, using Lucentis for the treatment of diabetic retinopathy would be considered an "off label" use. This means that patients would have to sign a consent in which they state that they understand that the drug is being used for a purpose for which it was not intended or approved. The second interesting point is that ophthalmologists are already commonly injecting Avastin, Lucentis' less expensive cousin, into eyes with diabetic macular edema. And, since it is made by the same company as Lucentis (Genentech), it is a direct competitor. The catch? Lucentis costs $2,000 U.S. Dollars per dose, but Avastin only $50.00. What is perplexing is why the National Eye Institute chose to study an off-label $2,000 drug rather than an off-label $50.00 drug, when many experts feel that the clinical benefits of the two drugs are likely to be similar.* --- Paul Krawitz, M.D., President and Founder Vitamin Science, Inc