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  • First Coast to Increase Payment for Avastin in Response to Academy Data

    At a meeting last week with Academy leaders, First Coast representatives said they would increase reimbursement for Avastin from $50 to $85. The Academy shared IRIS® Registry data documenting that ophthalmologists’ use of Avastin has declined, a factor we believe is linked to the low reimbursement rate.

    The First Coast commitment adds to the Academy’s 2019 victories with two other Medicare carriers. First Coast is important due to the high concentration of Medicare beneficiaries in Florida. Although it’s not the amount the Academy asked for, the 70% increase is a significant step toward a fairer payment for our member’ practices in the region.

    Due to shortages and rising costs for Avastin, some retina specialists have reported losses on these medications used for these injections. Each Medicare administrative contractor pays a separate rate for ophthalmologists’ off-label use of Avastin. The Academy also shared updated data we collected on the rising costs practices are experiencing.

    Last year, the Academy worked with local physicians to persuade Noridian and WPS to increase reimbursements in light of your rising costs. In response to our advocacy, Noridian and WPS increased their reimbursements to $94 and $90, respectively.

    First Coast promised to finalize the change within a few weeks of our Oct. 30 meeting. The MAC current payment of $50 for repackaged Avastin — the lowest reimbursement of any MAC. First Coast administers Medicare for Florida, Puerto Rico and the U.S. Virgin Islands.

    Costs of repackaged Avastin increased significantly after the U.S. Food and Drug Administration released additional compounding guidance on biologics in 2018. Under the new standards, 503(b) outsourcing facilities had to modify their processes for repackaging Avastin and change to a syringe that uses more drug..

    Our previous advocacy on this increased payment in 15 states: Arkansas, Colorado, Delaware, Iowa, Kansas, Louisiana, Maryland, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, Oklahoma, Pennsylvania and Texas, plus Washington, D.C.

    The Academy will continue to advocate on this issue and update you when we have final reimbursement details from First Coast.