Medicare bundles retinal physician examination and injection fees.
Medicare has now told physicians that they can not bill for an examination and an injection on the same day. Retinal physicians blame the cost of intravitreal injections and plan to use more Avastin off-label to curtail further medicare cuts. For years Genentech and now Regeneron have told retinal physicians that the payment for the expensive drugs used to treat various eye conditions come out of a "different pie" than the physicians payments. Now we know that this really isn't true since medicare chose to release data on physician reimbursements fully knowing that the cost of the drugs is reimbursed directly to the physicians and does not constitute a direct profit to the physician. These two separate issues just came up this week and retinal physicians are furious as it cuts their pay for each encounter of this type in more than half as examination usually reimburse at about $124 and the injection about $107. Many retinal physicians don't use Eylea and Lucentis because they are $2000/dose and the off-label Avastin is about $60/dose. I guarantee you that this will hit Regeneron going forward as physicians are forced to respond to this new "transparency of costs" brought on by medicare releasing this data in an effort to embarrass the profession.