Eyeworld

EW NEWS & OPINION November 2017 21 by Vanessa Caceres EyeWorld Contributing Writer diagnostic radiology, radiation on- cology, and gastroenterology. The highest total costs of a sin- gle category of ophthalmic medica- tions was for glaucoma medications at $1.2 billion. "Glaucoma medica- tions accounted for 8 of the top 15 drugs by total cost and 9 of the 15 drugs prescribed by total volume," the researchers wrote. Although brand medications made up 75% of the total glaucoma medication cost, they were only 35% of the total glaucoma medication volume. The next category for total eye medication cost was dry eye, for a total of $376 million—even though this was only the fourth highest by volume of prescriptions. Almost 99% of the total cost of dry eye med- ications was attributable to cyclospo- rine ophthalmic emulsion (Restasis, Allergan, Dublin, Ireland). The next two areas within ophthalmology that had the highest costs were in ocular inflammation and ocular infection. Researchers also considered cost savings if generics were substituted for brand names and calculated that such a move could generate $882 million in Medicare savings, or a 42% reduction of 2013 costs. Further negotiation by Medicare to obtain drug rates similar to those negotiated by the U.S. Veterans Association would decrease expendi- tures by 53%, or a savings of $1.09 billion. Weighing in The debate between branded and ge- neric drugs is often forefront in the minds of ophthalmologists, as they consider drug effectiveness versus cost savings and medication adher- ence. EyeWorld asked several sources to review the study's findings and weigh in. Here is an edited version of their comments. Lindsey De Lott, MD, assistant professor, Departments of Ophthalmology & Visual Sci- ences, and Neurology, University of Michigan Kellogg Eye Center, and study coauthor It's difficult to know exactly why ophthalmologists had the highest proportion of claims for brand name drugs, but I think there are a few possibilities: tiation using drug prices that are negotiated by the U.S. Veterans Administration. There was a total of 1,049,381 providers or facilities in the Medi- care Part D summary file, of which 1.9% were ophthalmologists and 2.4% were optometrists. Researchers found that the total Medicare Part D payment for drugs eyecare providers prescribed was $2.4 billion, or 2.3% of all Medicare Part D payments. "Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore also by total cost for eyecare providers compared with other providers," according to the researchers. The total was 38% by volume for eyecare compared with 23% for other provider types. "Ophthalmologists had the highest percentage of claims for brand name drugs (71%) when com- pared with all other medical special- ties with at least 1,000 providers," according to the study. About 67% of the claims from optometrists were for brand name medications. Following ophthalmology and optometry, specialties with the larg- est number of brand name claims were pulmonary disease, endocri- nology, infectious disease, allergy/ immunology, obstetrics/gynecology, Glaucoma, dry eye agents ratcheted up claims in analysis of Medicare Part D claims C ompared with other specialties, eyecare provid- ers prescribe more brand medications by volume, according to a recent- ly published study that analyzed eyecare providers' Medicare Part D prescribing patterns. 1 Led by Paula Anne Newman- Casey, MD, University of Michigan Kellogg Eye Center, Ann Arbor, the authors conducted a retrospective cross-sectional study to analyze Medicare Part D prescriptions in 2013. Prescriber public use and summary files enabled researchers to calculate medication costs by physician specialty and drug. They then estimated savings from generic or therapeutic drug substitutions in place of brand drugs. Researchers separated prescribed medications into disease-specific drug groups: glaucoma, dry eye, ocular inflammation, ocular infec- tion, allergic conjunctivitis, mydriat- ics, other ophthalmic, and other non-ophthalmic. Researchers also estimated potential savings from price nego- Study shows eyecare providers prescribe more brand medications than any other specialty 1. There is concern among eyecare providers that generic eye medica- tions might not be as effective. 2. There is a lack of comparative effectiveness research. It's diffi- cult to switch from a proprietary preparation of a drug tested in a clinical trial to a generic prepara- tion that hasn't been proven to be as effective. 3. For some common eye conditions, like dry eye, there are not many prescription drug choices that are generic. In 2013, the primary drug for dry eye was Restasis, for which no generic was available. Often, ophthalmologists just don't have other options. My colleagues and I are current- ly looking at geographical variation in prescribing brand and generic medications. We're also interested in exploring other policy questions relevant to the practice of ophthal- mology such as how reimbursement policies place value on various as- pects of clinical and surgical care. Donald Gagliano, MD, principal, Global Med- ical Innovation, and president, Prevention of Blindness Society of Metropolitan Washing- ton, Washington, D.C. When it comes to vision care, pa- tients expect high quality anatomic and functional outcomes. Oph- thalmology is a specialty care field requiring precise measures of effec- tiveness for both procedures and pharmaceutical interventions. I tend to use branded drugs for chronic diseases that need precise measures of effectiveness for small determi- nations of change and generics for more generalized purposes, such as post-procedure or post-exposure prevention. An attempt to control costs for medications of equivalent potency is a noble and meaningful effort. How- ever, as we learn more about these costs through studies like this, the value of other means of intervention may become even more meaningful by eliminating the need for con- tinued use of daily medications for chronic disease through improved prevention, surgical intervention, and gene-based therapy. Research highlight continued on page 22

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