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Capitol Health Call
September 14, 2011

Macular Degeneration Coverage

JAMA. 2011;306(10):1073. doi:10.1001/jama.2011.1253

Sen Herb Kohl (D, Wis) and Sen Sherrod Brown (D, Ohio) are asking Medicare to cover a much less expensive treatment option for individuals with neovascular age-related macular degeneration (AMD). The senators' request comes after a clinical trial showed bevacizumab (Avastin), at about $50 a dose, is equivalent to treatment with the current gold standard, ranibizumab (Lucentis), which costs about $2000 a dose (Martin DF et al. N Engl J Med. 2011;364[20]:1897-1908).

In a July 20 letter to Donald M. Berwick, MD, administrator of the Centers for Medicare & Medicaid Services, the senators formally requested a National Coverage Determination for the use of bevacizumab to treat age-related macular degeneration in the Medicare population (http://tinyurl.com/3tamprp). While the vast majority of coverage is determined on a local level, Medicare sometimes deems it appropriate to develop a National Coverage Determination for a therapy to be applied on a national basis for all Medicare beneficiaries.