What can past practice teach us about future costs?
Wet AMD drugs work too well?
Retinal leader Jay Duker, MD, speaking at last year’s OIS@ASRS meeting in San Francisco, said treatments for age-related macular degeneration historically have been priced fairly. But pharma players and healthcare payers believed the treatments such as anti-VEGF would only be effective for a year or two.
“We didn’t believe that we would be treating patients every four to six weeks for the rest of their lives,” Dr. Duker added. “I think that was a surprise to everybody.”
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But can we assign a dollar figure to the benefit?
“The reality of it is, patients are living 12 years after the initial diagnosis of wet AMD,” Dr. Duker says. “That might seem like an expensive medical bill to some. But when you look at the benefit that the patients have derived from it, it actually works out to be fairly cheap. Forty percent of patients continue working. Those patients would have been legally blind a year after diagnosis. So that savings to society is really tremendous.”
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Will wet AMD drugs save society a lot of money?
John Thompson, MD, notes that healthcare payers may not include health and mobility in their calculations.
“The fact that Grandma Rose can still drive doesn’t matter a bit to them. That doesn’t save the health insurance company or Medicare a penny,” he says. “It saves society a lot of money, and I think what we need to do is to turn the argument around. We need to show how it saves society money, you know, Grandma Rose doesn’t have to go into the nursing home.
Unfortunately, the health payers are getting more control and they’re putting in step therapy policies and things like that that could determine what we as clinicians use in our patients. And I think that’s a bad trend.”
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How will programs like bundled payments impact ophthalmology and innovation?
Trex Topping, MD, says receiving a single “bundled” payment to treat patients with conditions like Wet AMD will make it difficult to prescribe expensive therapies such as gene therapy. “We would find a big change in what physicians actually do in taking care of their patients,” he claims. “It’s a very sad situation that the government is going to force this on us.”
Dr. Thompson asserts such a system would be an overcorrection. “The problem is right now we’re incentivized to deliver as much care as possible,” he says. Bundled payments are “the exact flip side where you’re strongly incentivized to give very little care to your patients. And that’s bad.”
Unfortunately, the health payers are getting more control and they’re putting in step therapy policies and things like that that could determine what we as clinicians use in our patients. And I think that’s a bad trend.”
To hear these answers and more...
Join us on August 10 in Boston where Dr. Dugel and other luminaries will share their insights on the future of treatment for macular degeneration and diabetic macular edema. OIS@ASRS is the only place where KOLs, entrepreneurs, executives, and investors share the stage to discuss insights and innovation in retinal disease.
For a broader view of the anterior and posterior therapies, register now for the ninth annual OIS@AAO scheduled to be held November 9 in New Orleans.
