Safety, efficacy and cost factor into physicians’ decisions regarding glaucoma medication

Pros and cons between brand-name and generic medications must be considered.

Issue: September 10, 2015

Glaucoma medication costs, along with safety and efficacy profiles, can be an important consideration when prescribing medications, according to a glaucoma specialist.

Patients have to pay for glaucoma prescriptions on top of drugs prescribed for comorbidities such as cardiovascular disease and diabetes. Therefore, glaucoma specialists must find a balance among safety, efficacy and costs when prescribing to patients with multiple co-pays.

“We know that one of the important barriers to glaucoma medication adherence is cost,” Jason Bacharach, MD, of North Bay Eye Associates, told Ocular Surgery News.

Brand vs. generic

When prescribing glaucoma medications, cost and efficacy are two of the main considerations for glaucoma specialists, Bacharach said. Therefore, the choice between generic and brand-name medications comes into play when considering lowering medication costs without compromising drug safety and efficacy.

“There is an assumption that prescribing generics saves money,” Bacharach said. “Issues arise when making that assumption without considering unintended ramifications. Without strong data to support clinical equivalency of the generic version of an innovator product, we could be initiating additional office visits for patients, need for polypharmacy, untold side effects, and disease progression due to lack of efficacy with possible increase in need for surgical procedures.”

Also, color labels for caps, drop efficiency and ease of bottle use, underfilled medication in the bottle, and shipping for brand-name prescriptions are problems that patients and practices deal with, he said.

Brand-name products may be more effective in treating glaucoma. In a study conducted by Myers and colleagues, there was an additional reduction of 4 mm Hg in IOP when patients switched from generic latanoprost to brand-name bimatoprost.

There can also be a difference in inactive ingredients of generic medications, such as preservatives, buffers, toners and solubility factors, and clinical testing of generic drugs is not required, Bacharach said. Therefore, glaucoma specialists must decide if lower costs outweigh the additional efficacy that branded prescription medications may provide.

Patient adherence with costs

According to a presentation at the American Glaucoma Society annual meeting, 40% of 185 patients surveyed cited costs to be a barrier to adherence in taking their glaucoma medications.

Although brand-name prescription drugs can be more expensive than their generic counterparts, the costs of generics are increasing as well.

In 2013, retail prices for 280 generic prescription drugs used by Medicare beneficiaries fell by an average of 4%, the smallest decrease since 2006, according to an AARP report. In addition, 75 of the 280 generic prescription drugs had a price increase.

“We have found with the managed care coverage in our area, the costs of many branded medications are very competitive with generics,” Bacharach said.

Bacharach and colleagues conducted a survey of patients’ attitudes toward generic glaucoma eye drops, in which 67% of patients considered cost to be the biggest difference between generic medications vs. brand name. Twenty-three percent of patients attributed effectiveness to the difference, and 15% of patients said there was no difference. Also, 51% of patients surveyed said they were willing to pay more for a brand-name drop if their physician thought it was important.

Fixed combinations

According to Schmier and colleagues, fixed-combination therapies are the fastest growing category of glaucoma medications.

“Up to half of all patients being treated for elevated IOP need polypharmacy,” Bacharach said. “We can reduce the burden of medications with fixed combination.”

Fixed-combination therapies can reduce copays, lessen the burden of handling multiple bottles, avoid a washout effect, and lessen the chance of toxicity to the cornea from multiple bottles containing preservatives. Also, there can be added benefits such as reduced side effect profiles, Bacharach said.

PAGE BREAK

Recommendations

It is important for glaucoma specialists to weigh the varying options of cost, safety and efficacy when prescribing medications.

“We use available tools to keep costs as low as possible for our patients. Coupons for commercial and cash-pay patients [and] larger bottle sizes when available are examples,” Bacharach said.

If a patient needs to use a generic medication for cost containment, Bacharach suggested telling the patient that the generic prescription may be as effective but is not the same as the branded product.

“Treatment is individualized, and we will need to watch carefully to make sure the patient’s glaucoma remains under good control,” he said. “If the generic fails to maintain target IOP as well as the innovator product, then it is much easier to obtain a prior authorization from the insurer for the branded counterpart, usually at reduced co-pay.” – by Kristie L. Kahl

References:
Meyers JS, et al. Clin Ophthalmol. 2014;doi:10.2147/OPTH.S59197.
Newman-Casey PA, et al. Ophthalmology. 2015;doi:10.1016/j.ophtha.2015.03.026.
Rebong R, et al. Patients’ attitudes toward generic glaucoma eye drops. Presented at: American Glaucoma Society meeting; 2015; Coronado, Calif.
Schmier JK, et al. Clin Ophthalmol. 2014;doi:10.2147/OPTH.S63760.
Schondelmeyer SW. Rx price watch report: Trends in retail prices of generic prescription drugs widely used by older Americans: 2006 to 2013. AARP website. http://www.aarp.org/health/drugs-supplements/info-08-2010/rx_price_watch.html. Updated May 2015. Accessed July 27, 2015.

For more information:
Jason Bacharach, MD, can be reached at North Bay Eye Associates, 108 Lynch Creek Way, Suite 1, Petaluma, CA 94954; email: jbacharach@northbayeye.com.

Disclosure: Bacharach reports he is a consultant to various ophthalmic drug manufacturers. He does not report any direct conflicts.