• Medicare Part B Spending and Anti-VEGF Drugs

    Written By: Jean Shaw
    Selected By: Andrew P. Schachat, MD

    Journal Highlights

    Ophthalmology Retina, August 2018

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    Patel set out to tally the annual Medicare Part B costs associated with anti–vascular endothelial growth factor (VEGF) med­ications used by ophthalmologists. He found that aflibercept and ranibizumab account for 12% of the Medicare Part B budget. In addition, he estimated that switching to bevacizumab might save more than $2 billion each year.

    For this observational cohort study, the author analyzed data from 2011-2015 for intravitreal injections of aflibercept and ranibizumab. Compa­rable data on ophthalmology-specific injections of bevacizumab were not available, and this analysis excluded beneficiaries in the Medicare Advantage program, non-Medicare beneficiaries, and privately insured patients.

    Annual Medicare Part B spending for ranibizumab was $1.43 billion for 671,869 injections in 2011; this dropped to $1.15 billion for 573,796 in­jections in 2015. For aflibercept, annual Medicare spending was $1.08 billion for 518,836 injections in 2013 (the first year that data were available for the drug); the cost grew to $1.81 billion for 866,749 injections in 2015. For each drug, beneficiaries received an average of 4.8 injections per year.

    Although the author was unable to extract ophthalmology-specific data on bevacizumab spending, he noted that the numbers in his analysis could be used to estimate savings associated with switching to the less expensive medi­cation. For instance, for 2015 alone, he determined that switching from afliber­cept and ranibizumab to bevacizumab would have totaled $2.87 billion in Medicare savings.

    Despite this cost differential, the author noted that the choice of anti-VEGF agent is a complex one—and that switching to bevacizumab raises a number of issues, including concerns about the drug’s efficacy for certain patients and the need to rely on com­pounding pharmacies.

    The original article can be found here.