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Medicare Appears to be Reversing Avastin Ruling

October 28, 2009

In my October 12 Blog post I wrote about Medicare’s foolish decision to reimburse retinal specialists less than their costs for treating macular degeneration with the much- less expensive drug, Avastin.  This decision would cost our government millions of dollars annually.  I questioned how this system could ever manage healthcare.

I received an e-mail from both Dr. Joel Eichler (OCLI’s Retinal specialist) and the AAO today:

Kohl Indicates CMS Will Reverse Avastin Reimbursement Decision

The Academy is encouraged by an announcement today from Sen. Herb Kohl, D-Wis., chairman of the Senate Special Committee on Aging, who indicated CMS intends to reverse its Oct. 1 implementation of a new reimbursement code (Q2024) created for physicians (including ophthalmologists) who use smaller doses of Avastin for patient treatments. The Academy, along with the American Society of Retina Specialists, the Macula Society and the Retina Society, had challenged the new code’s implementation because it poses significant challenges for members’ practices and our patients’ access to care.

While the Academy is pleased by Kohl’s announcement, we await official word from CMS and details of its reversal, which are expected later this week.

I am hopeful this reversal will go into effect ASAP, the cost savings are enormous.  I will keep you all posted!

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