BLOG: MGD heats up: J&J lowers LipiFlow cost

ByDarrell E. White, MD

Some 5 years after I first made the suggestion, the new owners of the TearScience suite of meibomian gland dysfunction treatments — LipiView, LipiScan, LipiFlow — have made a very meaningful change in the cost of treating this ubiquitous scourge. At its annual sales meeting, Johnson & Johnson announced a new $100 price for the activators used in LipiFlow, the first price change since then TearScience CEO Joe Boorady announced a 50% cut at OSN New York in 2016, which brought the price to $175.

This is a huge development that will likely be felt throughout the dry eye disease world. TearScience/J&J has now put in place a pricing structure that will allow what is arguably the most effective MGD treatment to be utilized in a much more effective manner.

A little (personal) history is in order. I was on the receiving end of a gentle ambush at Caribbean Eye by the early adopters of meibomian gland imaging and vectored thermal pulsatile treatment for MGD. They had misinterpreted my disdain for the business model associated with LipiFlow at the time and felt that I had questions about its efficacy. Tipped off by some friends in the audience, I was able to turn the table a bit with gushing praise for the science behind LipiFlow and the excellent results obtained by using it. My objection was to the costs borne by the practices (approximately $100,000 for equipment, $350 per activator) and the disincentive to test that went along with a LipiView click fee. It was just wrong in so many ways.

At that time, I offered my firm conviction that not only was LipiFlow highly effective, but that it was almost certainly vastly underutilized. I likened LipiFlow to treat even mildly diseased meibomian glands to dental hygiene; both were probably necessary for the ongoing health of the structures treated. To the delight of the TearScience folks present, I suggested that LipiFlow was probably most effective if used every 6 to 12 months. For that to happen, I offered the blasphemous suggestion that it would take an activator price of no more than $100.

And here we are.

This opens up all kinds of practice strategies. Are you a DED referral center? You will continue to image glands with LipiView, LipiScan, a Meibox (Box Medical Solutions) or other method and treat to the findings. In all likelihood, your LipiFlow machine will now operate all day, every day. Big-time cataract surgeon with a high conversion rate to advanced IOLs? Look for preop LipiFlow to get baked into the upgrade fee for these IOLs. How about the newcomers to DED or smaller practices such as independent ODs? With such a low cost for the per-use disposables, now you can buy a free-standing LipiFlow unit, evaluate MGD at the slit lamp and make the call on treatment using Korb gland expressor (cost approximately $200).

You might ask, “Why now?” I have some thoughts (slow/no growth in sales, Alcon purchases iLux), but really, who cares? Vectored thermal pulsatile treatment of MGD business model v3.0 is nigh. However tardy, hats off to Mr. Frinzi and J&J for this bold move.

Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.