Eyeworld

OPHTHALMOLOGY BUSINESS 72 January 2018 by Vanessa Caceres EyeWorld Contributing Writer Patients using multiple medi- cations for glaucoma or expensive injections for macular degeneration also have frequent cost concerns, Dr. Myers said. One challenge that Ming Wang, MD, Wang Vision Institute, Nashville, Tennessee, notes is when a patient's insurance provider will try to prevent patients from getting certain medications because they're not on a formulary. This turns into a series of paperwork hurdles and can make getting appropriate med- ications harder, if not impossible, unless the patient is willing to pay out of pocket. Even though it's time-consum- ing to use staff resources to stay on top of medication costs, it's some- thing many ophthalmologists think they must do. The concern over medication cost rears its head most often for specific types of drugs. For example, new branded medications often work great but are expensive, said Maxwell Helfgott, MD, board member, Prevention of Blindness So- ciety of Metropolitan Washington, and Eye Physicians of Washington, Washington, D.C. Cost concerns bring practices into the savings game O phthalmic practices spend their days helping pa- tients see better, but for many there's another task involved: helping patients save money on eye medications. Without guidance from knowl- edgeable health professionals, it can be hard for patients, many elderly and on fixed incomes, to control drug costs. "It is heartbreaking to talk with senior citizens and other patients with limited incomes and hear the choices that they have to make be- tween food and medicine, between heart medicines that keep them alive and their glaucoma medicine that is holding off blindness," said Jonathan Myers, MD, co-director of the glaucoma service, Wills Eye Hospital, Philadelphia. He has heard of patients who try to stretch their glaucoma drops by using daily ones that last only 12 hours or by using medications every 2 days—both of which put sight at risk. Another example is with steroid medications that are used after surgery and dry eye medications, Dr. Wang said. Anne Negrin, MD, Purchase, New York, also finds that steroids come with a high price tag for pa- tients, as do antibiotics and non- steroidal anti-inflammatory drugs commonly prescribed after cataract surgery. Medications for ocular emergencies can cause sticker shock as well, she said. Here are some of the ways that physicians help slash medication costs for patients. The generic debate It's easy to say that ophthalmolo- gists will prescribe generic medica- tions when cost is a concern, but nowadays, there's more hesitation to do so, for several reasons. Generics aren't necessarily cheaper. "Some older, still quite effective generics, like doxycycline, have gone up massively in price, 10 to 20 times what they were several years ago," Dr. Helfgott said. It's also harder nowadays to find important generic drops, such as travoprost and dorzolamide/timolol, he said. "Generic substitutions can be helpful, although in some cases these can be almost as expensive," Dr. Myers said. Many ophthalmologists express concern over how much a gener- ic drug is a match for its branded counterpart, as they've had patients experience eye irritation, or the generic drug has simply not worked like it should. Dr. Wang prefers brand name steroids to ensure patients are get- ting the active components. "Often the generics settle out, and patients may be getting only a fraction of the intended dose and mostly the inactive ingredients," he said. "For some combination medica- tions, we only have generics in indi- vidual forms, requiring two co-pays and twice as much dosing, which is less convenient and drives reduced medication use," Dr. Myers said. Yet another concern with generics is what formulation a pharmacy may be using, Dr. Negrin said. For instance, a pharmacy may use a formulation that does well for a patient for several months. Then the pharmacy changes to another manufacturer, and the new formula- tion irritates the eye or doesn't work as well. Switching generic medications in this manner can undermine trust and credibility, not to mention consistency, according to Drs. Myers and Negrin. That said, generics sometimes can help patients save money, and many will prescribe them when appropriate. Dr. Helfgott will recom- mend them when they are available except in the case of suspensions. "Generic suspensions may not be bioequivalent to brand suspensions if the non-soluble active ingredient is not processed to the same size," he said. A point person If your office is big enough, desig- nate a point person to keep track of medication-related costs, discount cards, and related information. "We have a nurse who shares the responsibility with other staff members," Dr. Wang said. "She helps to handle prior authorizations for the medications and stays up to date on coupon programs and other assistance programs." Helping patients save money on medications continued on page 74

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