The journey of a new drug from laboratory to market is long and expensive, and particularly treacherous for a drug with a novel mechanism of action. Only a small proportion of truly innovative new drugs find their way into our therapeutic armamentarium, and the success of these innovative drugs often inspires the proliferation of “me-too” drugs—products developed to target a pathway of known viability.1 ^w1

Recently, however, two drugs sharing a novel mechanism, ranibizumab (Lucentis) and bevacizumab (Avastin), have been licensed for different indications, and the manufacturer is trying to keep their uses distinct. Although both drugs have been shown to be effective for the treatment of age related macular degeneration (AMD), a leading cause of blindness in high income countries, only ranibizumab has been approved by the US Food and Drug Administration for this indication.2 Both drugs were developed by Genentech, which was acquired by Roche in 2009, with Novartis holding the licence to sell ranibizumab outside of the US. However, ranibizumab is much more expensive than bevacizumab when used to treat AMD. The companies’ active discouragement of the use of bevacizumab for macular degeneration—creating a “not me” drug—has focused attention on important aspects of drug policy. In particular, how differing health financing systems have contributed to the wide variation in uptake of ranibizumab and bevacizumab for AMD among high income countries.