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BLOG: White flags fly over SkyVision: Surrendering to the power of PBM
What I learned at ASCRS ...
Once upon a time, the only thing you had to offer your dry eye disease patient was a simple, largely ineffective artificial tear and your deepest sympathy. This is very likely where DED got its reputation as the “crabgrass of ophthalmology”; it’s not a whole lot of fun to not be able to help folks who are uncomfortable.
The true dawn of the inflammation as the pathologic cause of DED actually started with the approval of Lotemax (Bausch + Lomb). If you recall, original Lotemax had an on-label indication for the treatment of punctate keratopathy. It wasn’t really until Allergan launched Restasis, though, that we had a drug that was specifically marketed to treat dry eye. I was on record at the time that it was mandatory that DED specialists become Restasis specialists. Allergan and Restasis pretty much had the market to itself (even when AzaSite was available) until the arrival of Xiidra (Shire). I am presently on the record that you must be an expert on at least one of these two medicines in order to treat dry eye.
However, I am now officially wrong because stating it that way implies that you, the dry eye-treating eye doctor, actually have a say in which medicine your patient will use. As of Jan. 1, 2018, this is patently false. If you wish to treat DED, you must now become an expert in the use of both Xiidra and Restasis. It does not matter one little bit which of the two you think is more effective or more appropriate for a particular patient. Your patient will use whichever medication their pharmacy benefit manager (PBM) tells you they will use. Once we diagnose a treatable dry eye, we look not to Duane’s, the Wills Eye manual, CEDARS/ASPENS or DEWS II, we look at our patient’s insurance card.
The white flag of surrender flies over SkyVision, while the Jolly Roger waves in the wind above the PBM headquarters.
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.