Medicare Revises Policy on Newer Lenses in Cataract Surgeries

Medicare has revised a policy to allow beneficiaries who undergo cataract surgery to receive high-tech replacement lenses that correct reading vision, rather than traditional lenses, provided that they cover the additional cost out of pocket, CMS announced on Tuesday, the Wall Street Journal reports. The newer lenses are considered "a significant advance in vision correction" over traditional lenses because they correct both cataracts and presbyopia, or loss of near vision, according to the Journal.

Under the previous policy, Medicare did not allow surgeons to charge beneficiaries for the difference in the cost of cataract surgery and implantation of the newer lenses. Medicare pays about $2,000 for cataract surgery, which includes the traditional lenses and fees for the facility and the surgeon. Surgeons charge about $4,500 per eye for younger patients who undergo cataract surgery and decide to have the newer lenses implanted. Under the revised Medicare policy, beneficiaries who undergo cataract surgery can decide to have the newer lenses implanted at an additional, out-of-pocket cost of $2,500 per eye.

According to the Journal, the revised Medicare policy "could widen access to other cutting-edge medical technologies" for beneficiaries. Leslie Norwalk, deputy administrator at CMS, said, "This is a model we can continue to use and explore when it fits into the category" of a technology improvement. She added, "There may be other technologies that come down the road where this approach may make sense -- we will have to wait and see." Norwalk said that legal issues -- such as concerns that surgeons could attempt to charge Medicare beneficiaries who undergo cataract surgery more for traditional lenses -- had delayed the revised policy.

Several companies that market the newer lenses, such as California-based Eyeonics, sought the revised Medicare policy with the help of Rep. Christopher Cox (R-Calif.) (Rundle, Wall Street Journal, 5/11). Cox said, "Now patients are free to choose," adding that the revised policy ensures that Medicare "does not discourage the development of new technologies, nor deny them to patients in need" (CQ HealthBeat, 5/10).

Andy Corley, CEO of Eyeonics, said, "This is clearly the biggest decision in our small company's life -- it expands our market four or five times. We believe this is a win-win for everybody."

Peter Bye, an analyst at Citigroup Smith Barney, said the revised Medicare policy increases the market potential for the newer lenses to 2.8 million implanted in the United States this year, five times the previously expected volume (Wall Street Journal, 5/11).