Eyeworld

JANUARY/FEBRUARY 2020 | EYEWORLD | 71 G Weighing the components Physicians must sometimes de- cide whether to prescribe Rock- latan or offer latanoprost and netarsudil separately. "I would generally prefer to use the Rocklatan in every almost every situation, if I can, but because netarsudil has been out longer, we do run into some instances where netarsudil is covered and Rocklatan is not," Dr. Brubaker said. In instances where some- one is allergic to latanoprost, he also avoids Rocklatan. In addition, Rocklatan must be kept refrigerated once opened, while the individual components when bottled separately don't have to be, Dr. Brubaker pointed out. If this is an issue for the patient, he pre- scribes the agents separately. Overall, Dr. Brubaker sees Rocklatan as a nice addition that most patients have been happy with. "We often have other options if it doesn't work, but it's always nice to have the opportunity to improve compliance while also improving IOP," he concluded. adding a beta blocker, I may be more prone to change them to Rocklatan because it's still at once-a-day dosing and you have two agents instead of adding another bottle of different medi- cation," Dr. Zhang said. In Dr. Trubnik's view, one of the keys to success with Rocklatan is to start patients early. "When it's added as a third or fourth drop, it gives the patient tremendous hyperemia," she said. While the FDA study pegged 90% of hyperemia with Rocklatan as mild, Dr. Trubnik found that when it was added late, it wasn't mild. "It was quite significant and patients were terminating it because they were so unhappy with the physical appearance," she said. Dr. Zhang, who tends to use Rocklatan early, finds that only a small portion of patients stop us- ing this because of the hyperemia. "Sometimes that initial hyperemia is due to the sensitivity to the agents, and the eye gets a little better," she said. Dr. Trubnik also tells patients about the possibility of red eye, explaining that it's not an allergic reaction. Dr. Brubaker said he tells patients one of the mechanisms of Rocklatan is via its vasodi- latory effect on the episcleral venous drainage. "I explain that often the cause of the red eye is that their existing conjunctival vessels are dilating to increase outflow of aqueous out of the eye," Dr. Brubaker said. In addition to the red eye, another common side effect is verticillate that occur in about 15% of patients. "They have wispy looking deposits in the corneal epithelium," Dr. Brubaker said. "I haven't noticed that it causes any visual com- plaints. It's more something that I recognize." After stopping the medication, this usually goes away in about 6–8 weeks. Reimbursement tips • Verify that Rocklatan is effective for the patient by first offering them a sample, Dr. Brubaker advised. • Once you've proven tolerability and efficacy, have the patient go to the pharmacy to deter- mine the copay. If it is high or if the insurance doesn't cover it, consider other approaches, such as use of company coupons, to get the cost down for patients, Dr. Brubaker said. • Prep your office to get prior authorizations and also prep the patient so that they don't get frustrated if it is not covered, Dr. Trubnik said. • In cases where netarsudil and latanoprost are covered, doc- ument that they are doing well on the combination, Dr. Huang recommended, adding that you can include the reasoning for prescribing Rocklatan, such as compliance or de- creasing medication burden. • Keep in mind that it can take time to figure out reimburse- ment issues, Dr. Brubaker said. During this period, offer patients another sample to help them get through the paperwork process. Source: Aerie Pharmaceuticals

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