For the past year, Genentech has pushed its new Lucentis drug to treat wet macular degeneration and, in the process, caused some controversy. Its older Avastin cancer med is widely used to treat the degenerative eye disease, but never approved for that purpose. And the biotech never sought FDA approval, either. Why? Well, Lucentis costs about 40 times more - a higher profit margin.

Now, though, Genentech is taking yet another step to restrict Avastin use. This time, the biotech is telling opthamologists it will soon be harder to get obtain the drug because sales won’t be made to compounders, citing FDA concerns about contamination when an Avastin vial is split into different doses; the agency issued a warning letter to a compounder recently. Moreover, Lucentis is now widely available.

Compounding pharmacies have, in fact, been under attack by drugmakers for some time over safety issues. So Genentech wrote retinal specialists to say its wholesalers will no longer sell to compounders. But opthamologists say they have used Avastin safely and the Genentech decision will likely make treatment much more expensive for some patients.

Some are undeterred. Raj Maturi, a retina specialist at Midwest Eye Institute in Indianapolis, says the extra steps of having to take Avastin to a pharmacy would add to the expense and risk. But he would try to get Avastin because “I don’t want to see my patients go blind because they can’t afford a $2,000 drug,” he tells The New York Times.

Of course, Genentech also stands to gain from this move - a vial of Lucentis is about $2,000, while Avastin costs between $40 and $50. Opthamologists say the decision will likely make treatment much more expensive for some patients. A Genentech spokeswoman tells Pharmalot that docs can continue to obtain Avastin vials from other sources, such as hospitals.

And she tells The Wall Street Journal that most patients are covered by Medicare, and those who can’t afford copays that can reach $400 a month are put in touch with charities.

“I think the retinal community is deeply saddened by the decision Genentech has made to restrict the availability of Avastin in the United States,” Phil Rosenfeld, a professor of ophthalmology at the University of Miami, tells the Times, adding that the move would have a “profound” effect on retinal practices. He and other ophthalmologists argue that Avastin has been used safely by many physicians for about two years and appears to be as effective as Lucentis.

He went on to say that he thinks Genentech’s move was for business reasons, because the cheaper Avastin was cutting into sales of Lucentis. In its last quarterly earnings teleconference with analysts, a Genentech executive said that Lucentis was being used to treat 55 percent of new patients and 50 percent of all patients. Retina doctors say Avastin accounted for most of the rest of the patients — or nearly half the market.