January 2018


Helping patients save money on medications

by Vanessa Caceres EyeWorld Contributing Writer

“It is heartbreaking to talk with senior citizens and other patients with limited incomes and hear
the choices that they have to
make between food and medicine.”
—Jonathan Myers, MD

Cost concerns bring practices into the savings game

Ophthalmic practices spend their days helping patients see better, but for many there’s another task involved: helping patients save money on eye medications.
Without guidance from knowledgeable 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 between 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.
Patients using multiple medications 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 medications harder, if not impossible, unless the patient is willing to pay out of pocket.
Even though it’s time-consuming to use staff resources to stay on top of medication costs, it’s something 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 Society of Metropolitan Washington, and Eye Physicians of Washington, Washington, D.C.
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 patients, as do antibiotics and nonsteroidal 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 ophthalmologists will prescribe generic medications 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 generic 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 getting 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 medications, we only have generics in individual 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 formulation 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 recommend 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, designate 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.”
“Our staff members, mainly the technicians, keep coupons and benefit information from pharmaceutical companies and offer these to patients,” Dr. Myers said. “Additionally, when medications are electronically prescribed, the technicians access programs that help to identify insurance for that patient so that we can address issues before the patient gets to the pharmacy.” That said, keeping up with that information takes a lot of time, he added.

Websites dedicated to cost comparison

Just like the old song says “you better shop around,” the same applies to comparing prices for medications.
“I always recommend that patients shop the prices. Pharmacy prices can vary enormously,” Dr. Helfgott said.
One tool that ophthalmologists and their patients have found helpful is Goodrx.com, a website that compares prices for many drugs at pharmacies and provides related coupons. The website says that it gets the prices from published data, price lists, claims records, and pharmacy-provided information.
Dr. Negrin also uses and has seen patients use apps that will help search for medication prices.

Manufacturer-provided discounts

It’s always a good idea to see if there are coupon programs available for certain drops, as these can reduce costs significantly, Dr. Wang said. This option can potentially work both for patients who have private insurance and those who are paying out of pocket.
There are also patient assistance programs from pharmaceutical companies for which some patients will qualify.

Mail-order pharmacies

Yet another option that patients can use nowadays is a mail-order pharmacy or a mail-order medication service. Discount Med Direct, with locations in Florida, Illinois, and Pennsylvania, requires prescriptions and works with a network of pharmacies both in the U.S. and abroad to find prices that are 30% to 80% less expensive than retail, said Judy Vobroucek, owner of Discount Med Direct. The medications are then mailed to the customer’s home. One way that Discount Med Direct cuts costs is by finding generic versions available internationally but not in the U.S. Although the company does not accept insurance, the savings still make the medications more affordable in many cases, she explained.
Within the eye realm, Discount Med Direct fulfills a large number of prescriptions for glaucoma drops and cyclosporine, Ms. Vobroucek said.
Dr. Negrin is happy to prescribe for mail-order services, especially for Medicare patients. She finds they often get a better price.
“Mail-order pharmacies, where patients can get a 90-day supply sent to them, often do provide a significant cost savings to patients,” Dr. Wang said. He doesn’t have experience with out-of-the-country pharmacies but does worry about counterfeit medications or less reputable sources from abroad. Dr. Myers has similar concerns.

Editors’ note: The sources have no financial interests related to their comments.

Contact information

: nfarano@youreyes.org
Myers: JMyers@willseye.org
Negrin: asnreis@gmail.com
Vobroucek: judyvobroucek@yahoo.com
Wang: drwang@wangvisioninstitute.com

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