BLOG: How dry eye doctors respond
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Maybe it’s just me. I mean, maybe I’m the only one who continually tilts at the great big pharma/PBM/insurance windmill trying to get them to cover the cost of medication.
Particularly expensive medication like Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), Cequa (cyclosporine ophthalmic solution 0.09%, Sun Pharma) and Xiidra (lifitegrast ophthalmic solution 5%, Novartis). Dr. Quixote. It’s crystal clear that statements by pharmaceutical companies that their medicine is “covered” are often meaningless. Platitudes like “the co-pay is going to be $30 after they reach their deductible” are worthless when a patient refuses to pay full price for that “one time only” uncovered med.
So naturally I reached out to my dry eye disease colleagues, many of whom are internationally renowned experts in the field, and asked them how they are handling this issue in their offices. The answer, while obvious and entirely unsurprising, should embarrass Big Pharma and will undoubtedly horrify Wiley Chambers and his buddies at the FDA. You see, literally every single DED doctor I queried had the same response when I asked them how they deal with the high cost of DED medications: They don’t. To a person, they have all bailed on the whole insurance gig. Every one of them starts off with a compounded version of cyclosporine A in a vehicle containing hyaluronic acid (developed by Dick Lindstrom).
Almost everyone I know is bagging the whole FDA-approved market and prescribing a compounded medication called Klarity-C made by Imprimis.
How about them apples, eh? All of the drama, the expectation and the exasperation around the issue of a “generic Restasis” a couple of years ago was all for naught. Yes, just as predicted, Klarity-C stings more than the branded options Restasis and Cequa, and it seems to take a bit longer to show a noticeable effect. Just like I have predicted when asked about “generic Restasis.” This makes perfect sense scientifically because cyclosporine is still hydrophobic, and the “magic sauce” in the vehicle is not hydrophilic, per se. Doesn’t matter. The “market” has voted. Some of the most famous DED doctors, some of whom have been on dry eye industry speaker and advisory panels, are saying to heck with insurance and embracing a cash-pay compounded option.
What’s next? Your guess is as good as mine. If the “pain” of encouraging patients to stick it out on Klarity-C is less than the “pain” of prior authorizations, denials and listening to an endless stream of complaints about cost, things don’t look all that good for the manufacturers of branded immunomodulators. We will likely get a look at how the FDA is going to approach “near generic” compounded versions of branded, patent-protected medications. Maybe this will push true generics from Mylan and Teva closer to approval and launch.
In the end, the lesson in all of this should be clear for both entrenched actors and newcomers: Coverage is meaningless. The only thing that matters is cost.
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