Generic Ophthalmic Drugs Could Save Millions for Medicare


Eye care providers found to prescribe more branded drugs than any other specialty.

Many older, Medicare-insured patients develop ocular conditions, such as glaucoma, chronic dry eye, inflammation, and infections. Treating these conditions can be very costly for Medicare, but findings from a new study published by Ophthalmology suggest that generic drugs may hold the key to reducing spending.

The authors found that eye care providers prescribed more branded drugs than any other specialty, which suggests they may be contributing to rising prescription drug spending.

The investigators evaluated the prescribing patterns of eye care providers, which results in $2.4 billion in Part D spending each year.

They discovered that switching to lower-cost generic drugs for ocular conditions would save Medicare $882 million annually, according to the study.

Currently, Medicare is unable to negotiate drug prices. If they were to engage in price negotiations similar to the Department of Veterans Affairs, Medicare could save $1.09 billion on ophthalmic drug costs.

“Lawmakers are currently looking for ways to reduce federal spending for health care, and policies that favor generics over brand medications or allow Medicare to negotiate drug prices may lead to cost savings,” said senior author Lindsey De Lott, MD, MS.

Branded drugs are typically triple or quadruple the cost of their generic versions. The authors believe that medication adherence may be at risk due to costly branded drugs.

The authors found that spending on glaucoma drugs was $1.2 billion in 2013, which accounted for half of the spending on ophthalmic drugs.

Dry eye medications were observed to be the second costliest category, with cyclosporine (Restasis) eye drops accounting for $371 million in spending, according to the study. There is no generic version of the eye drops, which were the most-used ophthalmic drug among Part D patients.

Overall, drugs to treat glaucoma, dry eye, ocular inflammation, and infection drugs accounted for 96% of ophthalmic treatments prescribed.

“Using a brand medication for a single patient may not seem like a big deal, but ultimately, these higher costs are paid by all of us,” Dr De Lott said. “In the case of Medicare, taxpayers are spending the money and most of the time, there is no evidence to suggest that brand medications are superior to generics.”

The authors noted that branded drugs comprised 79% of total Part D claims compared with one-third of claims for other specialties.

The investigators suggest that familiarity with branded drugs and a lack of data for generics may influence prescribing habits. Additionally, physicians may base their prescribing decisions on gifts from manufacturers, medical severity, and unwillingness to risk switching the patient to a different treatment, according to the study.

If patients struggle to afford their medications, the authors urge them to discuss lower cost treatments, including generics and therapeutic substitutions. They also believe that policy changes would help patients gain access to affordable treatments, according to the study.

“If the cost of generic medications increases, such as what occurred in 2014 when the price of generic prednisolone acetate and generic phenylephrine soared, changing providers’ prescription patterns would not help to reduce costs,” said senior author and Kellogg cornea specialist Maria Woodward, MD, MS. “A policy change, such as allowing Medicare to negotiate drug prices, would lead to more substantial savings.”

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