Increase the likelihood of patients getting their dry eye medications

Sometimes, the most difficult thing about being a doctor is getting the medications our patients need in their hands, and dry eye disease (DED) medications are not immune to this issue. Accomplishing this can mean many hours of phone calls, prior authorizations and, sometimes, different action steps all together. Therefore, it makes sense to have a protocol in place to decrease this challenge:

DOCUMENT

I recommend documenting all testing (TBUT, corneal staining, SPEED score etc.) and the use of prior OTC (e.g., artificial tears) or prescription therapies (e.g., eye ointments). Doing so assists in obtaining prior authorizations because it demonstrates patient need.

DESIGNATE A POINT PERSON

I suggest having a staff member keep tabs on the status of refills and prior authorizations (many of the pharmaceutical companies can help with this; often at no cost), so patients can get the specific DED drugs we have prescribed sooner rather than later.

SEEK INSURANCE REPS

I recommend asking your local insurance reps the coverage rates in your area for the most widely used plans and medications, as they have a software that lets you look up copays based on insurance for your area. This enables you to let your patient know the cost ahead of time, while also ensuring the pharmacy charges the correct amount. Local insurance reps are also a great resource for knowing what current rebates and coupons are available and how to use them.

EDUCATE PATIENTS

I suggest discussing with the patient how to use coupons or rebates when they are available. For example, most of these must be activated through the pharmaceutical company prior to the patient going to the pharmacy. If there is no coupon or rebate and the patient has neither insurance nor Medicare Part D coverage, I inform them about no-cost, non-membership discount cards, such as GoodRx and Optum Perks — we keep these cards in our office for patients who need them — and the fact that many of the pharmaceutical companies also have patient assistance programs that can offset a cost issue.

PRESCRIBE A 90-DAY SUPPLY

I recommend doing this when appropriate, as many of the insurance companies, especially those that utilize at-home delivery, provide medication at a lower cost for a 90-day supply vs. the per-month cost of a 30-day supply. (I let the patient know they can always ask the pharmacist for 30-day supply if cheaper.)

PREPARE A SPREADSHEET

Doctors are required to make decisions about medication substitutions and prescription refills. So that patients aren’t left in a holding pattern of sorts, I created a spreadsheet that my staff can readily access of acceptable substitutions and dosages for the most commonly prescribed DED disease medications.

WORK SMARTER

At the end of the day, we have to work smarter, not harder, when it comes to medication coverage. We know all too well that cost can prevent patients from achieving DED relief, and that while we, as the doctors, should have the ultimate say in the best treatment for our patients, this is, unfortunately, not the case when it comes to health insurance. OM

DR. KOETTING practices at Virginia Eye Consultants, and she is adjunct faculty for Pacific University, MCPHS, Salus University, Southern College of Optometry and the University of the Incarnate Word. She has received consulting fees or honorariums from Oyster Point, Glaukos, Quidel, Horizon, Ocular Therapeutix and Eyevance.