The controversy that has engrossed patients and docs in the US over two versions of the same Genentech drug - the older Avastin, which is used off-label to treat wet macular degeneration, and the newer Lucentis, which is approved by regulators but much more expensive - is now playing out north of the border.

Canada’s Common Drug Review, a federal body responsible for determining whether drugs merit coverage on provincial health plans, rejected Lucentis for coverage late last year. But the application is being reconsidered and a final decision is expected tomorrow, according to The Globe & Mail. [UPDATE: We should have noted earlier that, while the Common Drug Review makes recommendations about which drugs should qualify for coverage, provinces still make their own decisions.]

In the US, Genentech has been widely criticized for allegedly trying to steer business toward Lucentis at the expense of patients, especially since the biotech won’t study Avastin for the eye disease (but the NIH is doing so). In Canada, however, Roche markets the older Avastin, while Lucentis is sold by Novartis, which is pushing for the Canadian agency to okay coverage for Lucentis.

Lucentis backers say the government has a responsibility to reimburse patients for the treatment because it’s a better alternative than Avastin, which lacks sufficient clinical data. “Right now we have a drug that is approved that could be reimbursed to people every month,” says Keith Gordon, head of research at the Canadian National Institute for the Blind, which has received grants from Novartis.

“What is in the public interest here conflicts with what is in the private interest,” said Alan Cassels, a drug policy researcher at the University of Victoria. “It puts the medical system into an ethical dilemma.”