Eyeworld

EW CORNEA 86 September 2017 by Rich Daly EyeWorld Contributing Writer cy—with no financial interest—that will try to find the cheapest price for their branded medications. "If you go to your pharmacy and they tell you it is more than $120, give us a call and we will follow up with the pharmacy with which we have a partnership, and they will guarantee that three brand- ed medications will not be higher than $120—regardless of the cover- age or insurance," Dr. Mah said. "It empowers our surgical schedulers and technicians, who have reduced the number of callbacks and the number of times that our techni- cians have to ask the surgeons a question about what to do if the drug is not covered because now they know." On cost concerns, Dr. de Luise noted pharmaceutical companies' coupons for their branded medica- tions can sometimes produce a low- er price for the branded medication than that of some of its generic ver- sions, even if the insurance makes the patient purchase the generic. "In some rare instances, only one generic company is produc- ing the medication, and when the branded version goes off-patent, the price of the generic could potentially be higher than that of the brand," Dr. de Luise said. Generic concerns In the domain of oral medications, generic formulations are usually sim- ilar in efficacy and side effects as the brands, and are usually less expen- sive—generic formulations cost, on average, about 80% less than their branded counterparts, Dr. de Luise clinicians have "contracts" that patients are asked to sign if they re- quest generic prescriptions. Despite that, changes can still be made at the pharmacy level, where generic substitutions are common or the actual dosing request (i.e., 10 ml vs. 5 ml bottle size) is not honored as part of the prescription. Insurer restrictions for many medications have led some to utilize secondary channels to enable patient affordability, said John Sheppard, MD, professor of ophthalmology, microbiology and molecular biology, and clinical direc- tor, Thomas R. Lee Center for Ocular Pharmacology, Eastern Virginia Med- ical School. "Canadian pharmacies have been willing to provide fulfillment to prescriptions that are not other- wise available in this country," Dr. Sheppard said. "That varies from drug to drug. For example, the traditional loteprednol suspension is readily available from Canada, and Durezol [difluprednate, Novartis, Basel, Switzerland] is not at all." Other approaches The physicians and schedulers in Dr. Mah's office also stress to patients the need to pick up branded med- ication, including the brand name steroids. His office has developed a one- page sheet given to all cataract pa- tients that emphasizes the procedure is a one-time experience and that medication can play a role in the overall outcomes. Additionally, his office has part- nered with an independent pharma- There are some brand name medications for which physicians will go the extra mile to ensure patients use W hen a brand name medication is con- sidered key for the patient's recovery, ophthalmologists have found some steps can mini- mize the chances the patient will be diverted to a generic formulation. Francis Mah, MD, director of cornea and external disease, and co-director of refractive surgery, Scripps Clinic, La Jolla, California, stresses to patients before they go to the pharmacy that it is very import- ant that they pick up what has been prescribed. He also asks patients to bring the medication into the office to show at least a technician, if not the physician, what they received from the pharmacy. "Otherwise I don't know if there is a way for the physician to be cer- tain that what the physician writes for and wants the patient to get is actually picked up," Dr. Mah said. Among the reasons a patient may not pick up the branded medi- cation are cost, formulary coverage (which has to do with cost), and pharmacies incentivized to sell generics. Vincent de Luise, MD, assistant clinical professor of ophthalmology, Yale University School of Medicine, New Haven, Connecticut, agreed that the only way to confirm that the patient is getting a brand name ophthalmic steroid, if that was what was prescribed, is to have the patient bring the bottle to the office at every visit. Dr. de Luise noted that even if the ophthalmologist writes the abbreviation "DNS" ("Do not sub- stitute") or "Prescribe as written" on the prescription for the ophthalmic steroid, there is no guarantee that the brand name steroid will be filled as written or prescribed, either for insurance reasons or because the pharmacy is offering a bioequivalent generic to the brand name. Elizabeth Yeu, MD, assistant professor, Department of Ophthal- mology, Eastern Virginia Medical School, Norfolk, Virginia, said some Helping patients prioritize brand name drugs A s ophthalmologists, we have at our disposal a plethora of brand name and generic medications. To advo- cate for our patients, at times, additional efforts may be required to ensure that no substitutions are made. This is of great im- portance especially with the use of topical steroids. How does one know whether the active ingredient is at the correct concen- tration? Does the FDA mandate the drug vehicle or preservative concentration? Pricing concerns typically drive a significant number of patient questions and calls to a practice. It may be surprising to hear, but at times, the generic option, if produced by a monopoly company, may be even more expensive than the brand name product if a medication's patent has expired. These issues and others with respect to helping patients prioritize brand name drugs are discussed by Vincent de Luise, MD, Francis Mah, MD, John Sheppard, MD, and Elizabeth Yeu, MD, in this month's "Cornea editor's corner of the world." Clara Chan, MD, FRCSC, FACS, Cornea editor Cornea editor's corner of the world

• Blank Page
• Blank Page (1)