Eyeworld

SEPTEMBER 2020 | EYEWORLD | 45 G Contact Bacharach: jbacharach@northbayeye.com Cooper: coopadre@gmail.com Noecker: noeckerrj@gmail.com Radcliffe: drradcliffe@gmail.com It's an unfair situation for the patients, he said, because often the substitution is the branded product that's not on a good price tier. Dr. Radcliffe pointed to the shortage of dorzolamide, which he said began around fall 2017. Multiple generic manufacturers started running out of this, he said, though the reason was never figured out. It could be that some ingredient for it wasn't available, but since that time, dorzolamide has not been consistently available. The biggest problem with a dorzolamide shortage, Dr. Radcliffe said, is that one of the more common glaucoma medications uses a fixed combination of timolol and dorzolamide. When a patient goes to the pharmacy and they can't get this, he or she will go off the medicine. Dr. Radcliffe said he's seen people go blind because their pressure was out of control in the period between appointments when they were off the medication. Even now, he said it's hard to write a prescription for dorzolamide and be confident the patient will get it. A potential solution is compounding pharmacies, not spe- cialty pharmacies, which make their own dor- zolamide. But he said this option usually does not go through insurance, so there is a different element of difficulty when prescribing. Benefits to patients during the pandemic Dr. Bacharach said that anything that can be done to allow for longer refills is helpful. This can cut down on doctor/technician time, "ad- ditional touches" in the practice, and facilitate the acquisition of the product for the patient so they don't have to physically go to the pharma- cy. "I think in many cases, specialty pharmacies provide that advantage," Dr. Bacharach said. "The pharmacy world as we knew it has changed swiftly for all the players in the nascent COVID-19 world," Dr. Cooper said. "For those that survive, it will be a matter of developing close relationships with private physician prac- tices, urgent care, and small to large hospital units to minimize the impact on shortages along with overall supply/demand curves." Prescribing brand name medications Dr. Noecker noted that when he is prescribing medication through a specialty pharmacy, he will give the pharmacy a hierarchy of his choic- es of medication, so there are still options, but the pharmacy knows his top preference. Dr. Cooper thinks that using special- ty pharmacies has allowed him to prescribe brand name medications with greater freedom. "They can source brand medications I would like stocked and keep them in reserve for my patients who are in need of urgent and mainte- nance therapy," he said. "Additionally, they are less likely to start getting into a pricing conver- sation because they know I chose a particular medication for a reason." The primary reason to use specialty phar- macies is cost, Dr. Bacharach said. Though it might be easier in some cases for a patient to pick up a prescription at a pharmacy where they have a relationship, the cost is often prohibitive. Specialty pharmacies usually cap the cost and allow patients to get the specific medication they need, he said. Shortages of generic drugs Dr. Cooper said that while generic drug short- ages are an issue, he relies on multiple phar- macy streams, including specialty, retail, and mail-order. "While the latter two options lean on specific supply chains, which may have been cut off, specialty pharmacies can be nimbler and tap into their network that may include similar or unique sources to leverage their businesses," he said. Dr. Noecker has noticed shortages in generic drugs, noting that it seems like each week it's something different. "It's devastating when you have 30- to 40-year-old drugs that once were very cheap, and now you can't find them," he said. "Drug shortages are becoming the norm." Dr. Bacharach said he sees these shortages "all the time." "You read about it, then all of a sudden, you're in it," he said. It can be quite challenging when this happens because patients will call the practice looking for substitutions. Relevant disclosures Bacharach: None Cooper: None Noecker: None Radcliffe: None

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