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B.C. pays doctors a flat fee for treatment of macular degeneration, but pocket far less money if they choose the drug approved by Health Canada.

People in B.C. suffering from a degenerative eye condition are in a quandary over a provincial policy that allows doctors to profit by using a medication that's much cheaper than the approved drug.

In June, B.C. started to pay for treatments with Lucentis, a drug that can halt macular degeneration, a retinal condition affecting hundreds of thousands of Canadians over 45 years of age.

Lucentis — the only medication approved by Health Canada for treatment of macular degeneration — costs $1,575 for a vial that provides three doses.

Leanne Bernaerdt of Richmond said the doctor treating her 83-year-old mother decided to switch to another drug, Avastin, a drug that costs about $20 a dose but is intended for colon cancer patients.

Avastin is just as effective as Lucentis at treating macular degeneration, according to a U.S. study quoted by the advocacy group Macular Degeneration Support Canada.

Doctors' choice

But Bernaerdt did not want to take any chances with her mother's health.

"We were very concerned that the choice would not be my mother's choice."

Bernaerdt learned that B.C.'s program to pay for Lucentis gave doctors the option of substituting Avastin if they wanted to. The province pays doctors a $530 fee, no matter which of the two medications they use.

At $525 a dose, they break even when they inject Lucentis but profit by hundreds of dollars when they use Avastin.  

John Mulka, executive director of the Canadian National Institute for the Blind, and Dr. Alan Cruess, the past president of the Canadian Opthalmalogical Society, have both met with B.C. Health Minister Kevin Falcon and urged him to stop paying doctors to inject Avastin.  

Cruess said it's a slippery slope.   

"If this happens in this particular area of vision care, will it also happen in cancer care?" he said. "Are we just going to just use whatever the cheapest drug is and ignore the fact we have a system in place to approve new drugs?"

In the B.C. legislature Tuesday, Falcon said the fees for administering Lucentis and Avastin are being reviewed, but doctors should decide what drug to inject into their patients.