Summary
Ozurdex (Allergan) is now on the market and available for ophthalmologists to treat patients with retinal vascular occlusions (RVO).
While the technology and treatment may be sound, there may be significant hurdles to overcome from a billing standpoint.
Ozurdex may follow the same fate as Lucentis (Genetech). It must compete with a much cheaper drug which has comparable efficacy.
Analysis
Previously, I have written, with excitement about the emergence of several drug delivery systems. Overall, the timing of intraocular drug delivery systems is perfect. Ophthalmologists now routinely perform intraocular injections in an office setting; a significant practice shift compared to just 5 years ago.
Most intraocular delivery systems will be delivered in the same fashion, as an injection.
Ozurdex (Allergan) has gained FDA approval for treatment of retinal vein occlusions. While the FDA based its approval upon safety and efficacy, it was approved based upon comparison to laser photocoagulation for the treatment of RVO.
Intraocular injection of triamcinolone acetonide (Kenalog) has been used off-label for the past several years for treatment macular edema due to branch retinal vein occlusions and central vein occlusions. Ozurdex is designed as a sustained release of dexamethasone, also a steroid.
While the results of the two treatments are comparable, the costs and availability of the drugs are quite different. The pricing scheme is very similar to Lucentis (Genentech) and Ozurudex may follow the same fate as Lucentis due to the pricing challenges.
As with Lucentis, an ophthalmologist must order, pay and then bill for the product. We are not used to this (as compared, say to oncologists who administer chemotherapy in the office) and many of us have lost money using the anti-macular degeneration drug.
We are usually not compensated fully for the cost of the drug, as in the case of Medicare. We must then bill a co-insurance for the remainder of the cost of the drug or bill the patient directly. Most of the time, the amount of "gap" is lost. The paper work is too difficult. Too many practices lost money.
For those that are familiar with Avastin (Genetech), many ophthalmic markets now use Avastin exclusively; same efficacy, but almost no financial risk. Avastin is available for $15 to $50 a treatment depending upon your market.
Kenalog may be obtained for less than $10.
For these same reasons, I question Ozurdex's viability in the market. As there is already a competing, yet cheaper, alternative (intraocular injection of Kenalog), the pricing structure for Ozurdex may be to risky for physicians to adopt its use.
Randall V. Wong, M.D.
