Drug maker Genentech has been offering eye doctors secret rebates, apparently as an incentive to prescribe the drug Lucentis instead of a cheaper alternative, The New York Times reports.
The rebate program, which began Oct. 1, allows doctors to earn tens of thousands of dollars each quarter for high-volume use of Lucentis, and if they increase their usage from the previous quarter.
Lucentis is used to treat macular degeneration, a primary cause of blindness in the elderly. A single injection costs about $2,000 and is given as often as once a month. The alternative, Avastin, is another Genentech drug that is used to treat cancer, but that specialists say works just as well as Lucentis and costs $20 to $50 per injection. Avastin has not been approved for treatment of macular degeneration, though doctors are allowed to prescribe it for the condition.
Using the cheaper alternative means savings for Medicare, which reimburses doctors who purchase drugs at 6 percent about the average selling price. But the potential profit for doctors increases when a medical practice receives a rebate from a drug company on top of the reimbursement, as in the case of Lucentis. According to The Times, a practice qualifying for the largest rebates would get more than $58,000 in a single quarter.
Rebates have been paid for other drugs and are legal under certain conditions, but some doctors think they violate medical ethics.
“There’s no way to look at that without calling it bribery,” Dr. Greg Rosenthal, a retina specialist in Toledo, Ohio, told The Times.
Some doctors fear the rebates could encourage physicians to give injections of the drug more frequently, or to prescribe it for other off-label uses.
In a statement, Genentech said that rebate programs are a “common practice” and “help reduce the cost of our medicines for hospitals, pharmacies and doctors.”
Because Genentech asked doctors in the rebate program to sign a confidentiality agreement, it’s hard to say how many are getting the rebates. One physician, however, told the Times he believed the top 300 Lucentis-using practices are involved.
The American Academy of Ophthalmology is looking into the program.
Results from a clinical trial comparing Avastin to Lucentis are scheduled to be released by next spring.
