CMS Action Results in Recouped Cost Savings

(Washington, D.C.) – Following efforts by the American Academy of Ophthalmology with the help of the American Society of Retina Specialists, the Macula Society, the Retina Society and Congressional allies, the Center for Medicare and Medicaid Services (CMS) said that it will retract an Oct. 1 payment policy for small doses of Avastin. Avastin, a cancer drug, is used in smaller doses to treat eye diseases such as age-related macular degeneration (AMD).

The reimbursement rate change for Avastin heralded drastic cost consequences for patients and taxpayers. The new payment policy cut the reimbursement rate of small doses of Avastin to the point that ophthalmologists could not recoup their costs for the drug. As a result, treatment for AMD would likely have shifted from Avastin to the drug Lucentis, which has a substantially higher cost. Currently the lower-cost Avastin is the more prevalent treatment choice but that would have changed with the new policy.

“Congress worked along with ophthalmologists to make CMS aware of shared concerns to patient care, and the agency reversed implementation of its new reimbursement rate,” said David W. Parke II, MD, CEO of the Academy. “This is a win-win for all, particularly patients. CMS heard our concerns and acted in the best interests of everyone.”

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About the American Academy of Ophthalmology
The Academy is the world's largest association of eye physicians and surgeons—Eye M.D.s—with more than 27,000 members worldwide.  Eye health care is provided by the three “O’s” – opticians, optometrists and ophthalmologists. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases and injuries, and perform eye surgery. To find an Eye M.D. in your area, visit the Academy's Web site at www.aao.org.