Still, patients who have to cover 20 percent of the drug’s cost for injections each month typically choose Avastin, Braunstein said.
Data Weakness
Delving into the Medicare listings reveals the strength and weakness of the payment data on more than 880,000 medical providers. While it shows how the development of high-priced drugs and devices can dramatically skew the costs of care, the complicated system paints a confusing picture of doctors’ prescribing practices.
Welch, based in Hastings, Nebraska, said he was “shocked” to see himself listed as the ninth-highest paid doctor in America, taking in $9.5 million in 2012.
He cares for a large number of Medicare patients with macular degeneration, and administers Lucentis and Avastin, depending on his patients’ choice, he said.
The Medicare data lists Welch as performing 9,317 procedures in 1,268 patients, a number he says is in the right ballpark. He has a large number of patients because “I’m the only specialist in the area,” he said by telephone on April 9.
Misleading
Welch is also listed in the Medicare data as having 5,552 claims for Lucentis, but he says this is misleading.
The drug is billed by the unit and there are five units per injection, an approach he said may appear to inflate his rate. He bills Avastin under a code that can also be used for Eylea, which means it is impossible to tell how many claims he filed for Avastin by itself.
While he won’t say how much he made in total from the agency in 2012, Welch insisted that Lucentis isn’t a high- revenue driver for him. Each vial costs Welch $1,903, he said, and Medicare pays him a margin of about 2.5 percent, which results in $51 he can take home for each dose, he said.
In addition to reimbursement for the drug itself, Welch said he gets a fee, roughly $100, to inject the medicine into a patient’s eye. “In the long run, maybe the data release is beneficial,” he said, “but it sure is confusing.”