• Academy Continues Push for Reasonable Medicare Avastin Payment


    Academy leaders pressed officials from the Centers for Medicare & Medicaid Services again this week for adequate Medicare payments for repackaged Avastin.

    New data from the anti-VEGF utilization trends in the Academy's IRIS® Registry database documents the drop of market share for Avastin in Medicare fee-for-service from 45 percent in 2018 to 36 percent at the end of 2019. This data confirms what the Academy told CMS last summer would occur as a result of inadequate Medicare reimbursements.

    Complicating our request is uncertainty surrounding the White House announcement last month on an executive order that could implement an international pricing system for Part B drugs. The administration provided no details for how that system would work, instead saying it would implement changes if drug manufacturers don’t come up with their own solution by Aug. 24.

    Last year, Avastin experienced a supply shortfall due to changes to the syringes used to administer the drug, a result of a new interpretation of federal requirements. The new syringes require more drug, which drives up the price. The Academy at that time urged CMS to increase reimbursement to account for these added costs. 

    But CMS has not done so, and Medicare reimbursements remain inadequate for ophthalmology practices. The Academy is again asking CMS to ensure that Medicare pays adequately for this treatment option. 

    Medicare administrative contractors (MACs) price Avastin, but CMS could do more to highlight concerns. Last year, the Academy was successful in getting two MACs, Noridian and WPS, to increase their Avastin reimbursement rates.

    We continue to help our members make the case to other MACs that price increases, like that enacted by Avella and other major compounders, may leave practices with little or no margin or handling-cost coverage for Avastin. Since each MAC sets Avastin’s reimbursement rate, it is up to each of them to adjust. 

    We want CMS to acknowledge this negative effect on Medicare Part B drug costs and urge the MACs to take necessary actions to preserve patient access.