Arizona: ‘No’ on contact lens prescription extension

Legislators struck down a bill to extend contact lens prescription expirations in Arizona after optometry's advocates voiced concerns for patient safety and overall eye and vision health.

Introduced by Rep. Heather Carter (R-Dist. 15), Arizona H.B. 2523 initially sought extension of contact lens prescription expiration dates from one to three years, but upon review by the House Commerce Committee on Feb. 17 was defeated in a 6-2 vote following testimony from Arizona Optometric Association (AZOA) leaders and others.

Chief among considerations raised by doctors, extended prescription expiration dates unnecessarily put Arizonans' eye health at risk in the name of increased profit for online retailers. The measure raised the specter of patient harm from delayed treatment, reinforcing not only that contact lenses are U.S. Food and Drug Administration (FDA)-regulated medical devices requiring special doctor oversight, but also the importance of routine comprehensive eye examinations.

Annette Hanian, O.D., AZOA Legislation Committee chair, says state legislators understand that these devices can cause physiological changes to the eye and require annual reevaluation.

"The fact that the committee unanimously amended the bill to remove the most egregious portion and reduced the overall length of prescription from 5-6 years, to maximum of 2 years, and then voted it down says a lot," Dr. Hanian says. "Even in a state that is well known for appreciating personal responsibility and choice, a bill that pushes deregulation but risks patient ocular health isn't supported by a vast majority of our legislators."

Contact lenses are a safe way to correct vision; however, the very nature of contact lenses, physically resting on the human cornea, can affect the delicate ocular tissue in myriad ways. Therefore, contact lens prescriptions generally expire in one year in the overwhelming majority of states; and in states where a prescription is viable for longer, doctors still write one-year prescriptions for patients with eye conditions that require a shorter prescription period—as is standard—out of eye health and safety concerns.

Although legislators amended the bill, prior to the vote, down to a 2-year prescription expiration, one House Commerce Committee member voiced concerns over the manner in which 1-800 Contacts markets to consumers. Prefacing his 'nay' vote on H.B. 2523, Rep. Jay Lawrence (R-Dist. 23) presented a 1-800 Contacts email that was forwarded to him recently that swayed his opinion.

"It says, 'Dear Aaron, whoa, looks like a prescription on your account is about to expire. Yikes! That actually means a trip to the doctor's office unless you stock up on contact lenses before your prescription expires and save big when you order an annual supply,'" Rep. Lawrence read aloud. "That changed, absolutely changed, the (2-year) amendment that was offered by our chairman, and it makes it impossible for me to say, 'yes.'"

Earlier in 2015, Rep. Carter also introduced, in part, S.B. 1444 seeking to eliminate unilateral pricing policies and allow for contact lens substitution. That measure failed, but Rep. Carter then created an Ad Hoc study committee to explore Arizona's contact lens market with supporters of the UPP Bill—1-800 Contacts, Costco and others—as well as those against the bill, including AZOA. The committee didn't formally reach a conclusion, but AZOA expected legislation such as H.B. 2523 was imminent.

Dr. Hanian cautions that a bill isn't dead until the gavel strike signals the end of session, and she expects the bill's backers and 1-800 Contacts' lobbyists to explore further options until that point. However, AZOA and its member doctors will do what it takes to fight for patients and public health.

"Our member doctors have been essential to the defeat of H.B. 2523," Dr. Hanian says. "We have focused on building relationships with legislators over the years and our members have done a great job. This is something a company with a questionable reputation can't just come into the state and purchase."

She adds, "It will be another two months before our session is over; we will keep up our efforts for years to come. The AOA has really been a huge help for us by partnering with Coalition for Patient Vision Safety and See Clearly programs to assist with our on-the-ground efforts."

AOA, states continue fight against anti-patient legislation

Committed to patient safety and safeguarding the doctor-patient relationship, the AOA and state affiliates mobilized this past year against misguided legislation in a number of states that ultimately would have undermined quality care.

AOA President Steven A. Loomis, O.D., offered members the latest information with an interim progress report in February. Although nothing is final until state legislatures adjourn, several states currently have ongoing anti-UPP legislation, or other measures exploiting harmful contact lens loopholes, including New York and Utah. Also, California and Oregon recently defeated such legislation, and Washington has not had a bill introduced due to the overwhelming opposition voiced.

More states could see further action, but the AOA stands ready to help affiliates battle such harmful legislation.

"I am tremendously proud of the strong advocacy efforts of our member doctors and students, and our staff, in each of these states, as well as other states now bracing for attacks," Dr. Loomis stated in his member update.