Visudyne, a drug for macular degeneration, costs $2,500–4,000 for a course of treatment. Zevalin and Bexxar, used for non-Hodgkins lymphoma, can cost more than $20,000 per dose. While all these drugs can help certain patients, reimbursement has been a problem and some insurers have refused to pay.
Most biotechnology companies have assumed that Food and Drug Administration (FDA) approval is the major hurdle; after approval an insurance company would most likely pay. But that may be changing. While most FDA-approved biotech drugs are at least partially reimbursed, the Centers for Medicare and Medicaid Services (CMS), which sets the tone for payment decisions in the private insurance market, is taking an increasingly active role in evaluating which drugs it will pay for. Medicare is reviewing its reimbursement policies for the off-label use of four colorectal cancer drugs, including Avastin, estimated to cost $4,400 monthly, and Erbitux, which costs $10,000 monthly.
The ...
