A backlash from physicians convinced Genentech to change its course with Avastin

Physicians wanting to use Avastin to treat age-related macular degeneration received assurances from Genentech in late December that they will be able to continue purchasing supplies through authorized wholesale distributors.

Last fall, the company, which markets Lucentis for the same condition, had announced it would stop supplying Avastin to compounding pharmacies, which had been breaking it down into smaller vials for use in treating the disabling eye condition.

Avastin, which inhibits new blood vessel formation, has only been approved by the Food and Drug Administration for treating cancer. But many opthalmologists use it in small doses to treat AMD. A standard dose of Avastin costs about $2,000, while the amount needed for treating AMD is just one twentieth of that or $50.

As word spread among opthalmologists about the cheaper alternative, it undermined sales of Lucentis, a similar Genentech drug specifically formulated for treating AMD. The company sells Lucentis at a price comparable to its Avastin price, which it claims is necessary to recoup the costs of its development and clinical trials.

Eye doctors hailed news that Genentech will continue supplying them with Avastin through wholesale channels. "Working together, we have determined that physicians can prescribe Avastin and purchase it directly from authorized wholesale distributors and wholesalers can ship to the destination of the physician’s choice, including to hospital pharmacies, compounding pharmacies or directly to their office," the American Academy of Opthalmology said in a prepared statement.

"This process is one that the Academy and the American Society of Retina Specialists believe addresses the needs of most of their members. It is a significant step forward," the group said. However, eye doctors in some states may not be able to gain access to the drugs since regulation of distributors and pharmacies differ across the country.

Meanwhile, a Congressional investigation into Genentech's handling of the Avastin-Lucentis controversy is ongoing. At the urging of the Senate’s Committee on Aging, the Center for Medicare and Medicaid Services (CMS) recently approved paying for both drugs in a National Institutes of Health-sponsored clinical trial that will compare the use of Avastin and Lucentis in AMD patients.

The study is being led by physicians at Emory University in Atlanta. If the trial, whose results won’t be known for several years, shows the two treatments are comparable, CMS will start reimbursing physicians for use of the cheaper drug, which is now prescribed off-label.

—By Merrill Goozner

Merrill Goozner is a freelance journalist in Washington, D. C.