Macular Degeneration Treatment Cost

How Much Does Macular Degeneration Treatment Cost?

With Health Insurance: Copays or 10%-50% Coinsurance

Without Health Insurance: $9,000-$65,000+

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.

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.

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.

Post

Comments (5)

CostHelper News

7 Lesser-Known Discounts for the 50+ Crowd
As they age, members of the Baby Boomer generation don't like to admit that they're senior citizens, but they love getting discounts. It's kind of a quandary, because some of the best deals available are reduced prices for older folks. || Posted October 21 2013

7 Ways to Stretch Your Reduced Food Budget
End of the year budgets are tight for everyone, especially in this economy.It's especially hard for the millions of Americans who depend on government programs like food stamps to help make ends meet. || Posted November 11 2013



	‣ All CostHelper Blog Posts

What People Are Paying - Recent Comments

Wet AMD, left eye

Amount: $0.00

Posted by: Male in Austin, TX.	Posted: October 27th, 2021 09:10AM
Type of Treatment: Eylea injection every 6 weeks.	Provider or Clinic: Austin Retina Assoc.
Insurance: Medicare/ GEHA

$4635. Billed every time. Ins. Pays about $2700. I pay zero. Techs do exam & test. Doc walks in, injects, walks out, 2 minutes tops. Two years at this place. No improvement, no stabilization. Lump in macular.