Use of, and Medicare Expenditure on, Sutureless Amniotic Membrane Grafts Soared

Despite questionable evidence about their benefit for some conditions, including dry eye disease, use of sutureless ocular amniotic membrane grafts soared from 2011 to 2020, according to research findings reported in the journal Ophthalmology . As a result, the cost of the claims submitted to traditional fee-for-service Medicare for the grafts jumped nearly 30-fold, from $3.6 million in 2011 to $95.6 million in 2020.

The researchers who conducted the study said that Medicare reimbursement for the grafts fueled the surge in use and associated Medicare spending because it reimbursed ophthalmologists and optometrists the wholesale acquisition cost (WAC) price for the grafts instead of what they actually paid the manufacturers. That difference, which can be as much as $600, meant a profit