Eyeworld

EW GLAUCOMA 105 February 2011 March 2011 This is part two of a two-part series. Last month, experts discussed how newer blebless procedures are affecting their surgical strategies W ith the introduction of generic prostaglandins mere weeks away, glaucoma specialists are con- cerned about the potential impact on their patients. While some generic medications are touted as costing a mere $4, "that's not the case with most ophthalmic medica- tions," said Robert J. Noecker, M.D., vice chair, University of Pitts- burgh Medical Center Eye Center. "Anything that's not timolol or pilo- carpine isn't going to be on that tier. If the brand name is working for your patients and the generic is not a significant cost savings, there's not a good argument to switch." In his patient group, he said he hasn't seen any "trickle down effect" from various generic introductions— yet. "In March 2011, Xalatan (latanoprost, Pfizer, New York) goes generic, and that may affect the market," he said. Agreed Louis B. Cantor, M.D., director of the glaucoma service, In- diana University School of Medi- cine, Indianapolis: "We are entering an era where the number one glau- coma medication will have generic competition. The U.S. is becoming a highly generic-ized world. We've got generic beta blockers, generic carbonic anhydrase inhibitors, generic alternatives to Trusopt and Cosopt (dorzolamide and dorzo- lamide/timolol, respectively, Merck, Whitehouse Station, N.J.). Now with the introduction of a generic la- tanoprost, every class of glaucoma drugs will have a generic alterna- tive." The biggest unknown with generic prostaglandins (and la- tanoprost in particular) is how quickly the formularies will adopt the generic versions into their tiers and, perhaps more importantly, how well tolerated they will be, said Thomas W. Samuelson, M.D., attending surgeon, Minnesota Eye Consultants, Minneapolis, and adjunct associate professor, Univer- sity of Minnesota, Minneapolis. "Many unknowns remain—how many generic versions will be intro- duced? How equal will each of those versions be to one another and to the branded versions?" he said. "How much of the potential savings are going to be passed on to the pa- tients? How widely the adoption of generic prostaglandins is will de- pend on how well those questions are answered." Not all generic versions are vastly less expensive than their branded versions, Dr. Cantor added, citing Trusopt and Cosopt as exam- ples. "No one knows what's going to happen with generic Xalatan," he said. Kuldev Singh, M.D., professor of ophthalmology and director of the glaucoma service Stanford Uni- versity School of Medicine, Calif., said that it is possible that "there will be a fundamental change in the way generic glaucoma medications are used starting this year." Generics are generally distributed in a man- ner in which patients and physi- cians are not aware of which manufacturer's generic will be avail- able at any given pharmacy on a particular day. Historically, physi- cians have not recommended partic- ular generic formulations for the treatment of glaucoma, but given the large number of patients receiv- ing prostaglandins and the prolifera- tion of physician chat rooms on the internet, he sees "the possibility that anecdotal reports of particular gener- ics working better than others may lead to patients, at the recommenda- tion of their physicians, hunting for generics made by specific manufac- turers and avoiding others" that are deemed less effective. "It is possible that there will be clinical studies on generic prostaglandins versus each other as well as versus branded medications," Dr. Singh said. "One can imagine pa- tients walking into pharmacies and requesting particular generic ver- sions or visiting several pharmacies to find the generic recommended by their physician. Such a scenario may or may not actually occur, but given the large number of patients taking this class of medications, I would not be surprised if it did." An area of contention for glau- coma specialists remains how the Food and Drug Administration ap- proves topical ophthalmic drugs, Dr. Cantor said. "There's no require- ment to assess the generic against the branded version, which is differ- ent from how systemic generic drugs are evaluated. In ophthalmic ver- sions, the major components of the drugs can be up to 90% different from the branded version, so they are not truly equivalent." For example, ophthalmologists witnessed "glaring" differences be- by Michelle Dalton EyeWorld Contributing Editor Changes in glaucoma pharmacotherapy A glaucomatous optic nerve. Prostaglandins are used to treat glaucoma continued on page 106 How do you make the right staffing decisions? What strategies do you use to manage your employees? Are you complying with all the workforce regulations? You need the guidance of an experienced human resources consultant. HR Online is an exclusive ASOA member benefit that provides general information and current best practices. Learn more about HR Online at www.asoa.org.

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