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Reimbursement In Brief

Executive Summary

CMS drops reimbursement code for off-label Avastin use ahead of schedule: On Nov. 16, CMS formally drops the Q-code it had set up to reimburse physicians outside of the hospital setting for off-label use of Avastin (bevacizumab) to treat wet aged macular degeneration. The agency previously announced the Q-code would be dropped on Jan. 1, 2010 (1"The Pink Sheet" DAILY, Oct. 28, 2009). The Q-code generated controversy because it would under-reimburse physicians who use the drug over Lucentis (ranibizumab), which is approved for the indication but is significantly more expensive. Both drugs are manufactured by Roche/Genentech

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