Medicare savings in generic eye drugs

August 9, 2017
Dry eye, glaucoma meds make up most expensive ophthalmic medications.

Eye doctors could save Medicare north of $1 billion annually by prescribing generics over brand medications, suggests a new study.

Published in the journal Ophthalmology, the University of Michigan Kellogg Eye Center study reviewed eye doctors' 2013 prescribing patterns that resulted in $2.4 billion in Medicare Part D prescription costs, and concluded a switch to lower-cost generics could save $882 million annually, or if negotiating prices at U.S. Department of Veterans Affairs rates, could save up to $1.09 billion annually. That's because brand medications often cost substantially more than generics, and the top ophthalmic medications were either those with no generic equivalent or for one particular condition: glaucoma.

Reviewing 2013 data, ophthalmology accounted for a total drug cost of $1.8 billion, while optometry accounted for more than $339 million. In both professions, the dry eye medication, cyclosporine (Restasis), was concurrently the single most costly drug and the most frequently prescribed drug. It accounted for $371 million, while glaucoma medications made up half of ophthalmic drugs prescribed at a cost of $1.2 billion, the study notes. These two drug categories, plus ocular inflammation and anti-infectives, made up 95% of prescribed medications.

Furthermore, the study authors note that "eye care providers turned to brand medications for 79% of the total Medicare Part D payment claims (compared to one-third of claims among nearly all other specialties)."

So how did 2015 shape up for eye doctors? For the most part, those familiar names still top the charts across both professions as compared to 2013.

The top five most costly medications prescribed by doctors of optometry in 2015 accounted for a combined cost of about $370.3 million. These medications include:

  1. Cyclosporine (Restasis): $185.4 million.
  2. Bimatoprost (Lumigan): $70.2 million.
  3. Travoprost (Travatan Z): $62.2 million.
  4. Olopatadine HCL (Pataday): $27.1 million.
  5. Brimonidine Tartrate/Timolol (Combigan): $25.4 million.

Whereas, the top five most costly medications prescribed by ophthalmologists in 2015 accounted for a combined cost of about $1.2 billion. These medications include:

  1. Cyclosporine (Restasis): $435.5 million.
  2. Bimatoprost (Lumigan): $312.8 million.
  3. Travoprost (Travatan Z): $220 million.
  4. Brimonidine Tartrate/Timolol (Combigan): $149.2 million.
  5. Prednisolone Acetate: $139.3 million.

Click here to access CMS' Medicare Provider Utilization and Payment Data lookup tool to search by provider and view the full dataset. Read more about prescribing in the June 2015 edition of AOA Focus.

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