Eyeworld

EW NEWS & OPINION 22 November 2017 bottle utilized, among other factors, there may be a profound difference between topical and ocular branded medications and generics. The take- home message is that ophthalmol- ogists do what they think is in the best interest of the quality of care of their patients. For the majority of topical ophthalmic medications, I think the branded options are supe- rior. Interestingly, with coupons and discount codes that are provided by manufacturers, frequently there is a minimal cost differential between branded and generic medications. Tania Tai, MD, assistant professor of ophthal- mology, co-director of the Glaucoma Clinic, and director of the Microsurgical Laboratory, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York Not all eye medications have generic equivalents, and thus branded eye drops are used when necessary. For some eye drops, the branded versions may be less likely to induce an allergic response due to their pre- servative constitution, even though the active ingredient is the same. Occasionally, patients will insist on taking a branded form of the med- ication. I prescribe generics when I think the difference in efficacy and possibility of adverse reaction for the respective patient is non-signif- icant as compared to the branded medications. I also rely on generics for patients who cannot afford the branded versions. Jeffrey Whitman, MD, Key-Whitman Eye Center, Dallas If all generics were as efficacious as brand names, it'd be a better world. I'm suspect of the cost savings the study came up with. They say at the end it was all Medicare Part D. It's an interesting sub-study, but it's not all-comers. If we could put it in the major- ity of patients, I'd do intravitreal steroids. That would save frustration with patients getting in drops and would save Medicare and insur- ance companies a huge amount of money. The industry has to do a better job of studying generic efficacy com- pared to brand name. Patrick Gless, MS, associate director, gradu- ate programs in healthcare decision analy- sis, adjunct professor of pharmaceutical and health economics, University of Southern California School of Pharmacy and Schaeffer Center for Health Policy & Economics, Los Angeles If asked which provided specialty prescribed the most brand medica- tions, I would have guessed infec- tious disease or immunology. The leading autoimmune and virology drugs are biologics, and the nascent U.S. biosimilar market is only begin- ning to develop generic alternatives. However, it makes sense that eyecare providers are large prescribers of brand drugs given the unique nature of their specialty. Physicians may select branded medications when they trust the manufacturing quality of a partic- ular brand. Allergan, for example, produces several eye products. They are an established and trusted brand in this therapeutic area. Just as patients tend to prefer their spe- cialist to primary care practitioners, physicians have their preferences with the quality of certain brand manufacturers, particularly in higher risk conditions. The article correctly discusses that generic products may vary in the ease of use of the bottle. Any encumbrance to the administration of medicine from packaging to the delivery method to the frequency of dosing increases the likelihood that a patient will not take the medica- tion as prescribed. Payers may adjust their drug for- mularies based on Dr. Newman-Ca- sey's study findings or use the study to negotiate lower prices from brand eye medication manufacturers. For- mulary adjustments would incentiv- ize patients to select generics over brand medications when available and may eventually have a spillover effect on ophthalmologist prescrib- ing patterns. EW Reference 1. Newman-Casey PA, et al. Branded medi- cations and Medicare Part D: How eye care providers' prescribing patterns influence costs. Ophthalmology. 2017 Jun 16. Epub ahead of print. Editors' note: The physicians have no financial interests related to their comments. Contact information DeLott: ldelott@med.umich.edu Gagliano: nfarano@youreyes.org Gless: andrew@coastprgroup.com Mendelsohn: karensuedennis@gmail.com Tai: losak@optonline.net Whitman: whitman@keywhitman.com Alan Mendelsohn, MD, Eye Surgeons & Consultants, Hollywood, Florida The vast majority of my colleagues and I heavily utilize branded ocular medications. At national meetings, the topic of branded versus gener- ic is discussed over and over. The majority of experts explain that due to issues of bioavailability, the precise inactive ingredients, and the Study continued from page 21 CyPass ® Micro-Stent IMPORTANT PRODUCT INFORMATION CAUTION: FEDERAL (USA) LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A PHYSICIAN. INDICATION: The CyPass ® Micro-Stent is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma (POAG). CONTRAINDICATIONS: Use of the CyPass Micro-Stent is contraindicated in the following circumstances or conditions: (1) in eyes with angle-closure glaucoma; and (2) in eyes with traumatic, malignant, uveitic, or neovascular glaucoma or discernible congenital anomalies of the anterior chamber angle. MRI INFORMATION: The CyPass Micro-Stent is magnetic resonance (MR) Safe: the implant is constructed of polyimide material, a non-conducting, non-metallic, non-magnetic polymer that poses no known hazards in all magnetic resonance imaging environments. WARNINGS: Gonioscopy should be performed prior to surgery to exclude peripheral anterior synechiae (PAS), rubeosis, and other angle abnormalities or conditions that would prohibit adequate visualization of the angle that could lead to improper placement of the stent and pose a hazard. PRECAUTIONS: The surgeon should monitor the patient postoperatively for proper maintenance of intraocular pressure. The safety and effectiveness of the CyPass Micro-Stent has not been established as an alternative to the primary treatment of glaucoma with medications, in patients 21 years or younger, in eyes with significant prior trauma, chronic inflammation, eyes with an abnormal anterior segment, eyes with chronic inflammation, eyes with glaucoma associated with vascular disorders, pseudophakic eyes with glaucoma, eyes with uveitic glaucoma, eyes with pseudoexfoliative or pigmentary glaucoma, eyes with other secondary open-angle glaucomas, eyes that have undergone prior incisional glaucoma surgery or cilioablative procedures, eyes with laser trabeculoplasty performed ≤ 3 months prior to the surgical screening visit, eyes with unmedicated IOP less than 21 mmHg or greater than 33 mmHg, eyes with medicated IOP greater than 25 mmHg, in the setting of complicated cataract surgery with iatrogenic injury to the anterior or posterior segment, and when implantation is without concomitant cataract surgery with IOL implantation for visually significant cataract. The safety and effectiveness of use of more than a single CyPass Micro-Stent has not been established. ADVERSE EVENTS: In a randomized, multicenter clinical trial comparing cataract surgery with the CyPass Micro-Stent to cataract surgery alone, the most common postoperative adverse events included: BCVA loss of 10 or more letters at 3 months after surgery (8.8% for the CyPass Micro-Stent vs. 15.3% for cataract surgery only); anterior chamber cell and flare requiring steroid treatment 30 or more days after surgery (8.6% vs. 3.8%); worsening of visual field mean deviation by 2.5 or more decibels (6.7% vs. 9.9%); IOP increase of 10 or more mmHg 30 or more days after surgery (4.3% vs. 2.3%); and corneal edema 30 or more days after surgery, or severe in nature (3.5% vs. 1.5%). AT TENTION: PLEASE REFER TO THE INSTRUCTIONS FOR A COMPLETE LIST OF CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, AND ADVERSE EVENTS. © 2017 Novartis 9/17 US-CYP-17-E-2272 99169_US-CYP-17-E-2272_PI.indd 1 9/21/17 8:58 AM

• Blank Page
• Blank Page (1)