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November 25th, 2009
02:39 PM ET

Drug price gaps can be tough pill to swallow

By David S. Martin
CNN Medical Senior Producer

Talking about health care costs in July, President Obama asked this question: “If there's a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?”

Many ophthalmologists believe there is just such a blue pill out there. Only the red pill’s not twice as expensive. It costs almost 50 times much: $2,000 compared with about $45 for the alternative. And Medicare covers both.

What are the drugs? The expensive one is Lucentis. The other, Avastin. They’re not pills, really, but a medicine injected into the eye every four to six weeks to treat age-related, wet macular degeneration, a leading cause of blindness in seniors. With monthly injections, the annual cost difference is $24,000 versus $540.

It’s a difference that we, the taxpayers, underwrite. Lucentis cost Medicare $557.3 million last year, according to U.S. Centers for Medicare and Medicaid Services. That’s a figure that could rise as the population ages.

Many retina specialists think Avastin works as well as its more expensive rival, Lucentis, and roughly half of the wet macular degeneration patients are opting for Avastin, according to Dr. David F. Williams, president of the American Society of Retina Specialists.

Not surprisingly, Williams says, Medicare patients with supplemental insurance that covers the 20 percent co-pay are the most likely to choose Lucentis. (Medicare recipients ponied up $142.7 million in co-pays for Lucentis last year, according to government figures.)

Lucentis received FDA approval in 2006. The chemically similar Avastin was originally developed to treat cancer but its off-label use for wet macular degeneration predates Lucentis’ arrival on the market. To make this tale even stranger, both Lucentis and Avastin are made by the same company, Genentech, a division of the Swiss drug giant Roche. Can you guess which treatment the company advocates?

The National Eye Institute, part of the National Institutes of Health, is now conducting a head-to-head comparison of the two drugs. Initial results are expected at the end of next year.

Should the government require patients to choose the less-expensive drug? How about if the clinical trial shows no difference between the two?

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soundoff (3 Responses)
  1. GF, Los Angeles

    Since the government (taxpayers) is paying for the drugs and both work the same, patients should be given the cheaper drug. If the patient wants the more expensive drug, they should pay for the difference.

    November 25, 2009 at 15:09 | Report abuse | Reply
  2. jodigirl

    My question is this:

    Just because a study shows it works the same, does that translate into working the same for EVERYONE? If somebody is using Avastin, and it has been ineffective or had bad side effects, should they not be allowed to try Lucentis?

    I don't think medical science proves completely that studies showing an outcome reflect the outcomes for an entire population. Look at hydrochlorothiazide. For years it was touted as the first step for BP control. Now, after years of pushing it as first line treatment, we learn that it's not so good for a whole lot of people.

    Bottom line for me, I don't trust studies to be saying that what works for many will work for all. People should still have choices.

    December 9, 2009 at 15:59 | Report abuse | Reply
  3. Stephen J

    Problem with American brand named drugs is that they are simply over prices. There are so many middle men that it just jackes the price up, the money doesnt always go to the manufacturers.

    The smart ones are going to Canada to buy the drugs at over 30-80% savings over teh same drug in the US.

    Sure you pay a bit for shipping, but as long as you go to a licensed and Legit pharamcy youll be safe and save your self some coin! Example: http://www.ibenefitrx.com (And yes it is the FDA allowed)

    remember if you dont need prescription, your being scamed

    January 28, 2010 at 00:41 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.