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 |  | With Health Insurance: Copays or 10%-50% Coinsurance |  | Without Health Insurance: $9,000-$65,000+ |
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Macular degeneration is the age-related breakdown of cells in the part of the retina called the macula. There are two forms -- dry macular degeneration, in which symptoms appear gradually, and wet macular degeneration, a more severe form. Symptoms can include blurring or loss of central vision.
Typical costs: | - For patients covered by health insurance, out-of-pocket costs typically consist of doctor visit copays, prescription drug copays or coinsurance of 10%-50%. Treatment for macular degeneration typically is covered by insurance.
- For patients not covered by health insurance, treatment for macular degeneration typically costs about $9,000-$65,000, depending on which drug is used, for a two-year course of treatment with drugs injected into the eye to inhibit formation of and leakage from excess blood vessels. It typically costs up to $10,000 for two years of treatments with injection and photodynamic therapy, which works in a similar way. Laser treatment to burn leaky blood vessels, which is used much less frequently because only a small percentage of patients are candidates, typically costs about $1,700; it often needs to be repeated, and the procedure itself can cause vision loss.
- According to the American Macular Degeneration Foundation[1] , a vial of the brand-name cancer drug Avastin, used off-label[2] because it has not been approved by the FDA for macular degeneration, costs about $50 -- a total of $1,200 for monthly injections over the two years typically required -- while a vial of the brand-name drug Lucentis costs about $2,000 -- or a total of about $48,000 for monthly injections over the two years typically required; doctors also charge several hundred dollars or more for each injection. For example, Midwest Eye Care[3] in Nebraska charges $380 for one treatment with Avastin -- or $9,120 for monthly treatments for two years. According to Retinal Consultants of San Antonio[4] in Texas, a Visudyne injection with photodynamic therapy (PDT) costs about $2,000 per treatment -- or a total of $10,000 for five treatments over two years. And, according to Retinal Consultants of San Antonio[5] , one treatment with Macugen costs about $1,250 -- or more than $21,000 for treatments every six weeks for two years. Midwest Eye Care[6] charges $2,700 for one treatment with Lucentis.
Related articles: Macular Hole Treatment, Dry Eye Treatment, Cataract Surgery, Glaucoma Treatment, Eye Exam
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What should be included: | - For dry macular degeneration[7] , a doctor might recommend monitoring vision at home with an Amsler grid[8] .
- For wet macular degeneration[9] , in which a cluster of leaky blood vessels forms in the eye, a doctor might prescribe injections into the eye with bevacizumab[10] (brand name Avastin), a chemotherapy drug that is used off-label, or pegaptanib[11] (brand name Macugen) or ranibizumab[12] (brand name Lucentis). All three drugs block blood vessel formation and leakage. Injections typically are required once a month to every six weeks, depending on the drug, for about two years. Or, the doctor might recommend treatment with verteporfin[13] (brand name Visudyne) combined with photodynamic therapy[14] (PDT). The drug typically is injected into a vein in the body, then the doctor shines a special laser into the eye, causing the drug to close off blood vessels in the eye. Several more treatments might be needed, usually every three months.
- In laser photocoagulation, which usually requires local anesthesia, a doctor uses a laser to burn and seal off blood vessels. According to WebMD[15] , this treatment only can be used in about 15% of cases and has several other drawbacks.
Additional costs: | - A National Eye Institute study[16] found that patients with early-stage macular degeneration might be able to slow progression by taking certain antioxidants and zinc. Supplements formulated based on the study cost about $15 to $30 for a three-month supply.
Discounts: | - Many hospitals and doctors give discounts of up to 30% or more to uninsured/cash-paying patients. For example, Washington Hospital Healthcare System[17] in California offers a 35% discount.
- Some drug manufacturers offer patient assistance programs. Any patient without prescription drug coverage who also is not eligible for Medicare typically qualifies for Together Rx Access[18] , a discount card that offers 25%-40% off many brand-name drugs. Most companies also offer free drugs to patients who have no coverage and meet certain criteria.
Shopping for macular degeneration treatment: | - The American Academy of Ophthalmology provides an ophthalmologist locator[19] .
- The first-year results from a clinical trial by the National Institutes of Health[20] show the less expensive Avastin is as effective as Lucentis in treating macular degeneration. However, The U.S. Food and Drug Administration recently sent out an alert[21] stating that some patients in Florida had gotten eye infections from the off-label use of Avastin, injected into the eye.
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Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
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What People Are Paying - Recent Comments |
| Posted by: OldVictim in Seattle, WA. | Posted: November 4th, 2018 02:11PM |
| Type of Treatment: Avastin injection | Provider or Clinic: Harborview Medical |
| Insurance: Yes |
For a single injection of Avastin which I was told was a $50 drug I was charged over $600 for the medication, about $400 by the doctor and another $1400 by the clinic for the "procedure" which was an injection into my eye as I sat in the chair where they did the eye test. Even after insurance my part of this was $1400. There have been 2 treatments so far. They billed me for 10 doses each time and after a lot of complaining they did adjust it down to 5 doses, but the price was basically unchanged. |
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| Posted by: larry1440 in Seattle, WA. | Posted: August 24th, 2018 07:08PM |
| Type of Treatment: 2 Avastin injections | Provider or Clinic: UW Medical Center |
| Insurance: Yes |
It's costing me approximately $1500 per treatment AFTER the insurance coverage. It's approximately $2300 a treatment before insurance. The Avastin is costing nearly $800 per injection. I was told this was a $50 a dose medication. This represents 2 visits and treatment for 1 eye. Everything I find online says these prices are excessive. |
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External Resources: | - www.macular.org/lucentis.html
- www.fda.gov/RegulatoryInformation/Guidances/ucm126486.htm
- www.midwesteyecare.com/SubSection/index.php?SectionID=7&SubSectionID=192&ParentID=58
- www.retinasanantonio.com/services/macular-degeneration/treatment-for-wet-macular-d...
- www.retinasanantonio.com/services/macular-degeneration/treatment-for-wet-macular-d...
- www.midwesteyecare.com/SubSection/index.php?SectionID=7&SubSectionID=192&ParentID=58
- www.macular.org/dry.html
- www.amd.org/living-with-amd/resources-and-tools/31-amsler-grid.html
- www.macular.org/wet.html
- www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000352/
- www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000406/
- www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000394/
- www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000409/
- www.webmd.com/eye-health/macular-degeneration/photodynamic-therapy-for-age-related...
- www.webmd.com/eye-health/macular-degeneration/laser-photocoagulation-for-age-relat...
- www.nei.nih.gov/amd/summary.asp
- www.whhs.com/about/washington-hospital-discount-policy-for-uninsured/
- www.togetherrxaccess.com/p/prescription-savings/about-together-rx-access/enroll.aspx
- www.aao.org/aao/find_eyemd.cfm
- www.nih.gov/news/health/apr2011/nei-28.htm
- www.fda.gov/Drugs/Drugsafety/ucm270296.htm
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