BLOG: Dry eye slam poetry, or how I met your lawyer

ByDarrell E. White, MD

Slam, road rage ahead!

I’m suing the pants off you,

Dry eye medicine.

OK. Let me see if I have this straight. Big breath annnnd ... Allergan gets sued by generic drug makers Mylan and Teva in Texas so it donates its Restasis patents to a Mohawk tribe so that it can’t lose patent protection in the patent office, which leads compounding pharmacy Imprimis to poke the bear with an announcement that it will shortly produce a $0.99 compounded formulation of cyclosporine A and promptly gets its pelt sued by Allergan, which is naturally then sued by Shire for allegedly illegal bundling of products in the pursuit of Medicare Part D coverage, all before the federal judge in Texas invalidates all of the Mohawk tribe’s newfound wealth anyway. Phew. Out of breath.

Did I get it all?

Is it just me, or is all of this just one big pile of caca? Lost in the mix here are a couple of really interested parties who have been relegated to collateral damage status: our patients and us. Listen, I know what “life cycle management” is, and I really do understand the challenges that face companies that are about to face generic competition for a medicine that they developed (or bought). I admit to a bit of sympathy for the “double jeopardy” of actions that can be brought against patent holders in both federal court and the U.S. Patent Office. I know, and really like, many of the players in the arena here, but even I’m having trouble figuring out who the good guys are.

Cheering for the underdog in the Imprimis/Allergan tiff doesn’t feel quite right. Count me in the camp of those who don’t think it’s OK for a company to circumvent the process by making and selling something that is already FDA-approved. The Mouse that Roared story doesn’t fit.

How about that little game of Part D King of the Mountain? Hasn’t anyone noticed how big the top of that mountain is? How many untreated DED patients in the Medicare age group are loitering up there? All I want is the ability to make the best choice for my patients, and that means having as many options available. Access to DED medications is the single biggest barrier to treatment, and by that I mean financial access. This is not the time for me to rage against the folly of “price high and play games” to arrive at the actual cost of a medicine, though trust me, I have plenty of thoughts on that. We’re talking about Medicare, not some local market where it’s all about subterfuge and secrecy.

Put all my meds on every Part D formulary and get out of my way.

No matter how you look at all of this, every bit of this legal beagle ~~bullsh~~ stuff looks bad. It reflects poorly not just on those in the pharma business, but on all of us in the DED space. Do you think that maybe there are some fence-sitting docs out there who are staying on the sidelines because of this and not choosing to treat their DED patients? I’m certainly not going to sue anyone, but please don’t make me wax poetic on you again.

I have a haiku, and I’m not afraid to use it.

Disclosure: White reports he is a consultant to Shire, Allergan, TearLab, Rendia, TearScience, Omeros and Sun, and is a speaker for Shire, Allergan, Omeros and Sun.