Ophthalmologists Face Drug Dilemma

According to an article in The New York Times by Andrew Pollack, the pharmaceutical company Genentech is secretly offering rebates to eye doctors who prescribe their drug Lucentis (Pollack, Genentech Offers Secret Rebates to Promote Eye Drug).

Lucentis is an FDA approved drug to treat macular degeneration and is used in the form of an injection in the eye.  Injections cost about $2,000 each and can be given as often as once a month (Pollack).

Genentech has another drug called Avastin that is only approved by the FDA to treat cancer, but studies have shown that it is as effective as Lucentis when used to treat macular degeneration.  Avastin only costs about $20 to $50 per injection so many doctors are using the drug off-label to treat macular degeneration (Pollack).  Pollack states that the use of Avastin instead of Lucentis saves Medicare hundreds of millions of dollars each year.

Next spring, there will be a clinical trial comparing the efficacy of Lucentis and Avastin in treating macular degeneration, and if results say the drugs are equivalent, more doctors will switch to Avastin, causing Genentech to lose money.  Some are speculating that Genentech launched this rebate program to slow down that switch (Pollack).

Although the rebates offered by Genentech for Lucentis are technically legal, there is an ethical dilemma surrounding the issue.  Should doctors prescribe the more expensive drug to receive rebates, or should they prescribe the cheaper drug off-label?  Earlier blog posts of mine discussed the ethical implications of administering drugs off-label in exchange for kickbacks, but in this case, prescribing Avastin may help the financial standings of the government and patients, so is it okay? 

While I am weary of the use of drugs off-label, I personally think that ethically, if the doctor is prescribing the drug for the correct reasons and not just for monetary gain, it is less of an issue.  In terms of public relations, as this story hits the public, both the doctors and the pharmaceutical companies have valid reasons for prescribing/promoting the use of each drug, so I don’t see this turning into a crisis for Genentech or any of the various doctors who are using the drugs.  Rebates and kickbacks on drugs are so common that I don’t think the average consumer cares as long as they are getting the correct treatment.