Health care reform needs to extend to drug prices

By Gregory Tesluk

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In my 23 years of practice as an ophthalmologist, I have seen senior citizens become increasingly victimized by exploding drug costs.

Glaucoma is a progressive and potentially blinding disease of the optic nerve which can be treated by lowering the eye pressure with eyedrops.

Some patients require three or four different eyedrops. A study reported in the American Journal of Ophthalmology showed the yearly cost in 2006 for a patient on three brand-name eyedrops (Xalatan, Alphagan P and Trusopt) was $1,933. Incredible price increases since then for the same three eyedrops have made today's cost approximately $2,825 a year.

Even worse, certain eyedrops such as Xalatan, manufactured by Pfizer, are only provided in tiny 2.5-milliliter bottles that cost $85 each. This forces many patients to purchase new bottles every four to six weeks — requiring huge yearly co-pay costs.

Macular degeneration is a common condition in the elderly, which can cause central vision loss when abnormal blood vessels develop in the retina. As a retina specialist, I treat many patients with this condition by providing monthly injections, which can be necessary for up to two years.

Lucentis and a nearly identical medication called Avastin, both made by Genentech, have both been shown to be effective in preventing vision loss, although the FDA has only approved Lucentis — costing $2,000 per dose — for this treatment.

Avastin is FDA-approved for cancer treatment and costs about $50 per dose. Retinal specialists tried Avastin as an off-label treatment for this condition and studies showed it was an effective treatment.

Like many other retinal specialists, I prefer Avastin because it is 20 times cheaper than Lucentis and seems to work well. One estimate pegs the yearly national cost of using Lucentis exclusively at $1.2 billion versus $60 million if Avastin was used exclusively. A comparative study is being done to see if either drug is better, but the results are still a year away.

Instead of encouraging the use of the much cheaper Avastin, Medicare recently announced it would drastically reduce reimbursement to doctors' offices for Avastin, which will have the effect of forcing doctors to use the more expensive Lucentis, whose reimbursement was not changed.

Sen. Herb Kohl of Wisconsin wrote a letter to Medicare this month, asking whether Genentech lobbied Medicare to reduce reimbursement for the less expensive Avastin.

The seeds of this tidal wave of price increases were sown in 2003, when President George W. Bush pushed through the Medicare drug bill. This bill contained language inserted by the pharmaceutical lobby, which forbade Medicare from negotiating prices with the drug companies.

The law even prevents Medicare from purchasing drugs in Canada, where drug companies happily make a profit while selling at prices that often are 35 percent to 55 percent of U.S. prices.

The reform of our health care system is a perfect opportunity to reverse this disastrous legislation. The drug makers have increased their lobbying of Congress by 13 percent and are on track to spend as much as $270 million on lobbying this year. Just as in 2003, you can count on the drug lobbyists making sure that Obamacare won't touch their golden egg.

Dr. Tesluk is a board-certified ophthalmologist and retinal specialist who has practiced in Modesto since 1988.