Street Smarts

Be Kind to Your Patients' Wallets

Remember to consider the cost before you prescribe a medication.

By Dan Beck, OD
Leland, N.C.

ONE OF THE BEST THINGS about optometry is that it's constantly changing. The scope of practice expansion over the last decade has put optometrists in the position of primary eyecare expert. We have the ability to prescribe the largest number of ocular medications in the history of the profession. However, the licensed right to prescribe something, especially if it's the "newest and greatest," should be used judiciously. To borrow a quote from Spiderman, "With great power comes great responsibility."

One area of optometry, and medicine in general, that's too often an after-thought is the cost of prescribed drugs. All of us have written a script without considering the financial burden that may be placed on the patient. Let's consider a few examples.

Consider Generics

A 25-year-old white woman presents with unspecified red eye. After an exam, you conclude she has mild bacterial conjunctivitis with visual acuities of 20/20 OU and no corneal involvement. A popular treatment would be moxifloxacin (Vigamox, Alcon Inc.) or gatifloxacin (Zymar, Allergan Inc.) q.i.d. for 1 week. While both would be acceptable, generic ciprofloxacin would, in all likelihood, be just as effective and much cheaper. Even if a patient has prescription coverage, remember that copays may be higher than purchasing a generic outright.

Copays Can Be Costly

A 19-year-old African American man presents with significant ocular itching OU. You determine that he's suffering from seasonal allergic conjunctivitis. After he informs you that he has prescription drug coverage, you hand him a script for olopatadine (Pataday, Alcon Inc.) and he's on his way to the pharmacy. As he's checking out, the cashier informs him that he has a $40 copay for Pataday. Lucky for you, he doesn't realize that other drops on the shelf nearby, such as ketotifen fumarate (Zaditor, Novartis Pharmaceuticals Corp. or Alaway, Bausch & Lomb), probably would relieve his symptoms—at a cost of about $12.

Thrifty Patient Sees Just Fine

You just finished a contact lens exam on a longtime patient. He's never complained about his contact lenses and has never shown signs of contact lens abuse. He tells you he uses whichever multipurpose solution is on sale or is the cheapest. While many doctors would urge him to stick with a single brand-name product, his ocular findings contradict recommending any specific change in his care regimen. Why push him to spend more on solutions if it isn't really necessary?

Strive for Efficacy, Affordability

It's exciting when new ocular medicines become available. With more weapons to treat eye disease, we can offer better treatment options and outcomes for our patients. But we must remember that "new and improved" almost always means "new and improved and more expensive." Some situations call for the big guns, but you don't need a shotgun to kill a fly. Use what works but don't go overboard. Don't allow your urge to try a new drug cloud your concern for your patient's wallet. You'll both feel better if you prescribe an efficacious product that comes at a reasonable price. nOD