U.S. officials, defending a decision to release pay data that suggests some eye doctors made millions of dollars from Medicare, say the list should spur physicians to push lower-cost drugs to their patients.
Doctors say they’re being unfairly flogged for a system they can’t control.
The squabble centers on Roche Holding AG’s Lucentis, a $2,000-per-vial injection for a degenerative eye disease in seniors. Because the treatment’s cost is included in their reimbursement, eye doctors dominated the list of Medicare’s top earners. By listing payments without that explanation, doctors say the government is trying to embarrass and pressure them into switching patients to a lower-cost option.
“It’s a back-door way of rationing rather than being up-front with patients,” said John Welch, a Nebraska eye doctor who was listed in the Medicare data released April 9 as the ninth highest-paid physician in the nation in 2012.
Medicare paid at least $915 million to ophthalmologists whose patients used Lucentis in 2012 rather than a similar medicine, also from Roche, that carries a price tag 40 times cheaper and works equally well, according to studies.
The government hopes the newly public data on physician payments will help control costs in the $604 billion Medicare system by pressuring doctors to be more concerned about the price of the drugs they use, said Jonathan Blum, principal deputy director of the Centers for Medicare and Medicaid Services, which oversees the health program for the elderly and disabled.
Little Choice
“Under the current statutory framework we work under, we cannot encourage or require physicians to use lower-cost drugs that are available,” Blum said in a call on April 9, answering a question about the choice between Lucentis and the cheaper version, called Avastin.
“These are the kinds of questions we want to be asked” by the public and the press, he said.
Doctors immediately pushed back, saying the profit margins they get are similar no matter which drug they use, and it is the patient who makes the final choice.