Quick Hits

Glaucoma patients alter spending, dosing behaviors with Part D benefit, study shows

The savings let them take a full dose, stop shopping internationally, and more.

By Zack Tertel, Senior Editor

A recent study of Medicare patients showed that once they were able to spend less money for their glaucoma medications, they changed their cost-saving behaviors. Some of these behaviors would be considered poor patient choices.¹

The study, which analyzed the impact of the Medicare Part D prescription drug benefit, showed a drop in these patients’ efforts to save money on their glaucoma medications, including:

• Taking smaller doses. Decreased from 9.4% of patients to 2.7% of patients.

• Skipping doses owing to cost. Decreased from 8.2% to 2.8%.

• Price shopping. Decreased from 26.2% to 15.2%.

• Purchasing outside the United States. Decreased from 6.9% to 1.3%.

• Spending less money on other items to save for medications. Decreased from 8.0% to 3.5%.

According to the study’s lead author, Dana Blumberg, MD, MPH, assistant professor of Ophthalmology at Columbia University’s Edward Harkness Eye Institute, the results show that policy level changes can have a tremendous impact on patients and their access to prescription medication, which also impact patient care.

Despite the decrease in cost-saving measures, the study also found that the percentage of patients who did not fill prescriptions because of cost remained relatively stable, only decreasing from 3.4% to 2.1%.

“Some patients continued to say that the medication costs were too high even after they obtained prescription drug coverage,” Dr. Blumberg says. “It may be the costs were out of their budget but it may be that the meds weren’t as high a priority as getting food on the table or their other financial commitments.”

To increase the rate of patients filling prescriptions, Dr. Blumberg expressed that physicians’ efforts should differ depending on the type of patient. Some younger patients with lower incomes might not perceive medication as a priority and may feel invulnerable to vision loss. For these patients, she recommends educational intervention on the impact of IOP-lowering glaucoma medications to avoid vision loss. However, other patients may have limited access to care. “For these patients, it may be a matter of making sure they have someone who can get them to the store and get their prescription filled.”

REFERENCE

Glaucoma procedures, 1994-2012

Results from a study looking at trends in types of glaucoma procedures performed on Medicare patients between 1994-2012 surprised the researchers. Overall, the total number of procedures went down 16%, despite the percentage of enrollees increasing by 9%. Considering the study participants were older and glaucoma is a disease primarily of an aging eye, the results were unexpected, wrote the researchers. Noninvasive procedures, like mini-shunts, are gaining ground. Arora BA, et al. Use of various glaucoma surgeries and procedures in Medicare beneficiaries from 1994-2012. Ophthalmol. http://tinyurl.com/qbl5byj

An ophthalmic giant passes

Robert M. Sinskey, MD, was an innovator, philanthropist.

By René Luthe, Senior Editor

Robert M. Sinskey, MD, who developed and promulgated phacoemulsification, trained more than 3,500 early phaco adopters since the 1970s, but still found time to dedicate his ophthalmic gifts to those in need in Ethiopia, died last month.

The ophthalmic community is mourning the passing of Dr. Sinskey. Called a pioneering cataract surgeon by his peers, he initiated the use of IOLs in children with cataracts. He served as medical director emeritus of the Southern California Lion’s Eye Institute, clinical professor of ophthalmology at the Jules Stein Eye Institute at University of California, Los Angeles, and on the staff at St. John’s Health Center in Santa Monica, Calif. In 1955, he became the first full-time instructor at the UCLA eye clinic.

Dr. Sinskey also was president of the American Society of Cataract and Refractive Surgery in 1999; and he was inducted into the ASCRS Ophthalmology Hall of Fame in 2005. He served on the board of the ASCRS Foundation, through which he funded the Sinskey Eye Center in Addis Ababa, now the largest charitable eye hospital in that city. According to the ASCRS Foundation, the eye center treats more than 16,000 patients annually, and helps to train Ethiopian surgeons.

Dr. Sinskey’s fellow ophthalmologists are reminded of his legacy in day-to-day matters as well: He invented the Sinskey hook, one of the most widely used instruments in cataract surgery, and the Sinskey posterior chamber IOL, among other surgical instruments. His contributions to ophthalmic literature include more than 30 articles and textbook chapters.

And he was a vintner; His wines, grown in the Napa Valley in California, were 100% organic, according to his website.

David W. Parke II, MD, CEO of the AAO, had this to say: “With Dr. Sinskey’s passing, ophthalmology has lost one of its innovative and significant members. From IOLs to pinot noir, he always strove for nothing but the best. He will be sorely missed.”

Larry Patterson, MD, Ophthalmology Management’s chief medical editor, met Dr. Sinskey earlier this year, for the first time. “It’s strange. The day before I learned of his passing, I was discussing him and his accomplishments with my surgery center staff,” he says. “Fortunately for ophthalmology, his legacy will live on.”