from the editor

Industry Relations Under Scrutiny

More and more, we're reading articles in major newspapers, journals and magazines about the relationship between our industry and its physicians. New ophthalmologists need to pay attention and be aware of how media coverage affects clinical practice.

While it may seem that this discussion involves academic researchers who perform clinical studies and receive honorariums or other financial support from companies for speaking engagements and research, the issue is much more complicated. For better or worse, the relationships that exist between ophthalmologists and our industry are extensive and complex.

Businesses in our industry fund educational activities for residency and teaching programs. They provide a stream of revenue for activities that may not exist otherwise.

They also fund continuing medical education events for ophthalmic organizations and academic departments. Academic departments aren't forced to cover the costs of speakers for grand rounds or resident graduation, and everyone benefits from hearing national speakers.

Most of the innovations that have occurred in clinical eye care have come from industry or have been supported in some part by industry. Most new drugs have come to market through industry-supported clinical trials and basic research. Many devices under development or recently approved originate from companies rather than universities. Without these contributions, the practice of ophthalmology would be quite different today.

Recently proposed reforms are aimed at limiting the access of industry representatives to staff. Industry reps often aren't allowed into clinical areas and aren't allowed to support resident-centered events, such as journal clubs. While some of this makes sense, a complete ban on interaction limits a valuable source of information for new ophthalmologists who need to learn about new drugs and devices.

While many in private practice feel insulated fromthe reforms, those who deal with hospitals may see a direct effect on patient care. Many institutions are enacting "no sample" policies for patients based on the assumption that samples drive the prescribing of more expensive, branded products. For example, in some facilities, postoperative medications can't be given to patients to take home for use after surgery, and samples can't be given in the office. For some patients, this may be the difference between taking prophylactic antibiotics and not taking them.

Whether or not you agree with this trend toward minimizing industry interaction with clinicians, you need to be aware of the potential implications that accompany the proposed mandates. The rules may differ from the norm during training. Furthermore, new mandates have the potential to change how we treat patients and acquire information about new therapeutic options. Understanding exactly what the rules are in each situation will help chart a course through the ever more complicated sea of ophthalmology practice.

Robert J. Noecker, M.D., M.B.A. Chief Medical Editor, New Ophthalmologist Associate Professor of Ophthalmology University of Pittsburgh School of Medicine Vice Chairman and Director, Glaucoma Service University of Pittsburgh Medical Center Eye & Ear Institute noeckerrj@upmc.edu

a letter from Genentech

Dear esteemed residents, fellows and new ophthalmologists,

At some point in your education, each of you made the admirable decision to dedicate your career to helping people see. As a new ophthalmologist, you've further emphasized your commitment to patients by entering the field during a time when record numbers of aging baby boomers may encounter threats to their eye health.

As you fulfill your commitment to protect and enhance the eye health of your patients, Genentech will be there to support you and your patients. Since 1985, when our first product was approved, Genentech has donated approximately $1 billion in free medicine to uninsured patients, and since 2005 we have donated more than $140 million to various independent, nonprofit organizations that provide copay assistance. We continue to strive to ensure no patient goes without a needed treatment due to financial barriers alone. As such, we have met with representatives of the American Academy of Ophthalmology and the American Society of Retina Specialists to discuss ways to enhance our access programs to improve enrollment timing and eligibility requirements.

As an outcome of these discussions, Genentech recently introduced updates to our patient and provider support program for Lucentis^® (ranibizumab injection), now known as Lucentis^® Access Solutions™. One change we're implementing is that we'll now confirm, in writing, if a patient is or may be eligible for free drug within 48 hours in most cases, including providing conditional enrollment for eligible patients with unclear insurance coverage but who otherwise qualify medically and financially. In addition, we've expanded our Genentech Access Solutions eligibility criteria (for all of our products) to include patients who meet approved medical criteria and an annual adjusted gross income of up to $100,000, as well as patients who have reached their maximum lifetime insurance limits. We're also increasing our support to independent nonprofit copay organizations, with a particular focus on groups with fast and efficient processes in place.

With these changes, we hope to ensure that no eligible patient is left without access to treatment, and that practices feel confident in using our programs when needed. As this one letter doesn't offer us the opportunity to provide every update or detail of how these programs work, we welcome any questions and encourage you to contact us at (866) 724-9394 or visit LucentisAccessSolutions.com.

Be assured that throughout your career as an ophthalmologist, Genentech will share your commitment to helping patients access the best treatments possible.

Best Regards,
Alexander Hardy
Senior Director, Reimbursement,
Managed Care and Customer Operations
Genentech, Inc.