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July 2, 2014

Drugs for Macular Degeneration, Price Discrimination, and Medicare’s Responsibility Not to Overpay

Author Affiliations
  • 1George Washington University, Washington, DC

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(1):23-24. doi:10.1001/jama.2014.6672

The release of information reporting payments made by the Medicare program to individual physicians in 2012 revealed that ophthalmologists accounted for a substantial proportion of physicians who received payments exceeding $1 million.1 A major factor contributing to these high payments for some physicians was reimbursement for treatment of age-related macular degeneration (AMD) using intravitreal injections of ranibizumab, an anti–vascular endothelial growth factor (VEGF). These drugs used for treatment of AMD are controversial not only because of their expense and the substantial payments made to some physicians who administer these drugs, but also because some anti-VEGF agents are sold at markedly different prices to different customers, representing a form of price discrimination.