Eye Docs Gain Access to Avastin

What's behind Genentech's decision yesterday to allow opthalmologists to directly order Avastin, the anti-cancer drug that also blocks excess blood vessel formation in aging eyes? The company in October announced that as of January it would stop selling the biotech drug to compounding pharmacies, where the eye docs could get the small doses needed for treating macular degeneration.

I suspect the company realized that it couldn't lose the good will of the eye doctors, who also use Genentech's Lucentis to treat the condition. Most physicians believe there isn't a dime's worth of difference between the two drugs since they both work on the same cellular process and have both produced very good results (we won't know officially that Avastin works just as well as Lucentis until a National Institutes of Health-funded comparison trial is completed in several years).

However, Lucentis costs $2,000 a shot compared to just $40 or $50 a shot for Avastin, which is usually packaged in large vials suitable for cancer treatments. Break down those large vials at a compounding pharmacy and, voila, it's dirt cheap (which proves that the actual cost of producing these biotech wonder drugs is very low).

When a well-insured patient (read low co-pays) walks into an opthalmologist's office, they get Lucentis. But for many poor patients, those on fixed incomes or those with high deductibles and co-pays, the physician is likely to go for the cheaper alternative. If the company followed through on its plans to remove that alternative, it is likely that we would have seen a gray market for Avastin emerge, with local opthalmologists cutting deals with local oncologists to get small doses of the drug. Genentech must have figured it is better to get a few hundred million in sales from the well-insured than turn cancer and eye doctors into surreptitious gray marketers.