Avantis vs Lucentis

My babysitter is in her 70s and is an absolute angel of a woman. She has been taking care of my daughter for the past 4 years while I work. A few years back, she was diagnosed with wet macular degeneration in one of her eyes. She had been receiving the Avastin shot and it has really seemed to help her, so much that she was able to stop treatments for a while. In the past month, she has noticed her eye sight deteriorate and has gone back in to see her doctor, and he has confirmed that she needs to start treatment again.

She is enrolled in a Medicare Advantage plan here in FL and all of a sudden, her doctor says he can no longer give her the Avastin shot and that her insurance only covers Lucentis (she has not changed plans from when she previously had received the shots). The problem is that her out-of-pocket expense with the Lucentis shot is $400 – something that she cannot afford on a monthly basis – not even close. I did some research a few days ago and had found some articles that said that Avastin is much cheaper, so much so that even paying for it out-of-pocket is much cheaper than the $400 co-payment for Lucentis. She has tried talking her doctor into giving her the Avastin shot (since it has worked so well in the past for her and because it is something she could actually afford), but with no luck. Her eye sight was getting so bad that she went ahead and paid for the Lucentis shot with her credit card and is hoping she can come up with some way to get the Avastin shot when it is time for her next treatment. Her doctor says that because she has insurance, he can only give her Lucentis. He also said he has consulted with his lawyers to see if there was any possible way he could give her the Avastin shot as he had previously, but that they had said no.

Is there anything she can do to get the Avastin shots again? She is retired and is on a VERY tight budget. Any direction you can provide would be, from the bottom of my heart, greatly appreciated. I worry that if she cannot find a cheaper alternative to the $400 Lucentis shots, she may not be able to get the shots every month as needed and may have to compromise her sight. She lives alone and her ability to drive is vital.

Any tips you might be able to provide are very much appreciated.

[John C Hagan III, MD, FACS, FAAO]

Her options are limited. Both drugs are made by the same company and the company has done everything it can, in my opinion, to make it difficult to use Avastin. Also since its and off brand use in the eye the fear of litigation because of the rapacious trial lawyers in this country also raise huge legal issues.

The only thing I can think of is to call other ophthalmologists on the insurance plan she has and ask if any of them would be willing to use Avastin. This is another example of how the lack of lawsuit reform adds literally billions to the cost of medical care.

JCH MD