Glaucoma medication costs impact compliance

Dr. Fechter, who is in private practice in Augusta, GA, pointed out that in recent months, the unemployment rate in the United States stood at about 10%, with from 8 to 45 million individuals either uninsured or underinsured.

Coupled with this is the fact that 76% of physicians prefer to prescribe prostaglandin analogues and with good reason-the drugs are efficacious, safe, well tolerated, and have high patient adherence.

Other contributory factors are that some insurance programs do not cover prostaglandin analogues at all, patients may not instill glaucoma drops correctly and waste precious drops, and some patients may have to choose between buying food, heating oil, or medication.

Become more aware of generic glaucoma drugs, Dr. Fechter advised.

"The bottom line is that expensive drugs may lead to noncompliance," he said. He cited a survey of 9,290 patients, 17% of whom said that the high cost of their medications made them noncompliant.

Drug pricing

Dr. Fechter also presented other interesting data, namely, that 88% of physicians said that cost was an important consideration when making medication choices, 77% would sacrifice efficacy to make drugs more affordable, but a surprising 80% had no idea what drugs actually cost.

To educate himself about the prices of drugs, Dr. Fechter visited local pharmacies in the Augusta, GA, area and found discrepancies between name-brand glaucoma drugs and generic glaucoma drugs.

At the time of Dr Fechter's research, for example, he found that among the alpha-agonists, the name-brand drug cost $82 for a 1-month supply compared with $14 for a 1-month supply of the generic; the name-brand topical carbonic anhydrase inhibitor cost $126 versus $14 for the generic; the oral carbonic anhydrase inhibitors cost $336 compared with $24 for the generic; the name-brand dorzolamide/timolol combination cost $162 compared with the $34 generic; the brimonidine/timolol combination, for which no generic is available, ranges in price from $70 to $102; and the beta blockers ranged from $54 for the brand-name to $4 for the generic.

There presently is no generic prostaglandin analogue, but that should change soon; the current prices range from $112 to $82. Dr. Fechter believes that the availability of a generic prostaglandin analogue will have a huge impact on physician prescribing habits and patient compliance.

This situation, however, is not as simple as choosing an inexpensive generic beta-blocker over the name-brand prostaglandin analogues. The prices actually paid by patients depend on their insurance status. Physicians may not have to sacrifice efficacy, for example, for a Medicaid patient who may be charged only $3.20 for a month's supply of a prostaglandin analogue. Members of the military pay nothing for their drugs, whereas individuals with Medicare and a secondary insurance may pay only $5 a month for a prostaglandin analogue. The price varies between $20 and $70 per month for patients with standard insurance plans, whereas uninsured patients can expect to pay the full retail price of $75 to $82 for a month's supply of the same drug.

Doing the homework

Patients should know about the online Medicare Prescription Drug Plan. Using this Web-based plan, patients can determine the insurance company that pays the best benefits for their medications. Another education source is http://www.EyeCareAmerica.org/, which can direct patients to various assistance plans to obtain drugs.

Surgical alternatives may be beneficial for some patients. A laser trabeculoplasty costs $50 or a glaucoma drainage implant with a patch graft costs $618, once the patient has satisfied the Medicare deductible. Ophthalmologists can help their patients save money in many ways, he reinforced.

"We should consider their insurance coverage, prescribe lower-tier or generic drugs when possible, prescribe a 3-month supply to lessen the co-payment, use a mail-in pharmacy, educate patients about medicine assistance and indigent-care programs, consider surgical options to treat glaucoma, and educate patients about correctly instilling topical glaucoma medications," Dr. Fechter concluded. "Listen, ask, be knowledgeable, and have resources available."

FYI

Herbert P. Fechter, MD
E-mail: hfechter@augustaeye.com

Dr. Fechter has no proprietary interest
in the subject matter.