Lawrence Hoffheimer: Legal Hurdles for Retina Specialists

A former D.C. healthcare attorney and founder of the Macular Degeneration Association discusses legal problems faced by retina specialists when providing care to their patients with AMD.

Despite not being a physician, Lawrence Hoffheimer, a former healthcare attorney who practice in Washington D.C. for more than 30 years, has a unique perspective on macular degeneration. 

Chairman and founder of the Macular Degeneration Association, Hoffheimer saw his mother suffer from the wet age-related macular degeneration in the 1980s and would later develop the condition himself. Hoffheimer has used his experiences and his platform to lobby and increase awareness for the disease on a national level. 

Hoffheimer sat down with MD Magazine at the 2019 American Society of Retina Specialists Annual Meeting to give insight on potential legal hurdles faced by retina specialists when looking to provide care for their patients.

Hoffheimer explained that while there used to be more hurdles in getting coverage and reimbursement for therapies, such as anti-VEGF injections, these are less common than they were just a few years ago.

MD Mag: What legal hurdles do retina specialists face when trying to provide care to patients with macular degeneration?

Hoffheimer: The biggest is probably the reimbursement issue. Although, sight may appear to be very valuable to most people, if it's not covered by insurance and Medicare it's so expensive that it would not be treated. Now, you do have the off-label drug Genentech has that was discovered who would do the same thing if it's if it's mixed properly — that's a cancer drug and some doctors perform that because it only cost $50, but that's as far as far as legal of regulatory debate — the main thing is it's covered now and there's no reason to believe that new anti-VEGF therapies which are on the drawing board and then some will also gain Medicare approval.

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