Switching to generics could save millions, researchers say.

Eyecare providers prescribe more brand medications by volume than any other provider group, making them big influencers of prescription drug spending in the U.S., according to a new study.

University of Michigan Kellogg Eye Center researchers analyzed the prescribing patterns behind the $2.4 billion in annual Medicare Part D prescription costs generated by eyecare providers. A switch to lower-cost generics could save $882 million a year, according to a press release. Negotiating prices like the deals afforded the U.S. Veterans Administration could save $1.09 billion in total annual ophthalmic drug costs.

Eyecare providers turned to brand medications for 79 percent of the total Medicare Part D payment claims, according to the release. That compared with one-third of claims among nearly all other specialties.

“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 and Kellogg neuro-ophthalmology specialist Lindsey De Lott, a medical doctor who is a member of the U-M Institute for Healthcare Policy and Innovation.

Brand medications can cost triple or quadruple the cost of generics. Medication adherence is at stake, researchers say, if patients don’t fill a brand medication prescription because it costs too much.

The study of 2013 data, which became available in 2015, ranks the kinds of medications eyecare providers prescribed. Glaucoma medications made up half of prescription ophthalmic drugs prescribed at a cost of $1.2 billion.

The second costliest category, dry eye medications, was attributable mostly to a single drug. With no generic equivalent, cyclosporine (Restasis) eye drops accounted for $371 million in spending and was the most-used eye medication among Medicare Part D beneficiaries.

These two categories, plus ocular inflammation and infection medications, made up 96 percent of drugs prescribed.

Eye conditions and drugs prescribed may differ for non-Medicare populations, meaning the results may not apply across different insurance types. For example, glaucoma is more common among the elderly age 65 and older who qualify for Medicare Part D.

“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,” 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 study authors described some barriers to using generics, including:

  • Familiarity: Even when generics become available, clinicians can get comfortable prescribing what’s first on the market.
  • Lack of data: There are very few comparative effectiveness trials between brand and generic medications.
  • Industry influence: Physician acceptance of industry money, speaking and consulting fees, rebates, gifts and drug company samples can influence prescribing patterns, even if doctors think they don’t.
  • Medical worries: With any infectious disease of the eye, there’s concern that it might get worse. Bacterial culturing of eye infections is limited to a subset of cases leading physicians to give prophylactic coverage, just in case. But doctors tend to provide that coverage with medications that are much stronger than needed for prevention.
  • Optimizing care: If a patient is optimized with a medication, it can be challenging to switch to something else.

The research, with senior author and Kellogg glaucoma specialist Dr. Paula Anne Newman-Casey, earned best poster honors for the Kellogg team at the 2016 American Academy of Ophthalmology national meeting in Chicago before it was published in the journal Ophthalmology.

Although healthcare providers prescribing more generic medication as first-line therapy would contribute to significant savings for Medicare, authors say there are times when only policy change will help.

“If the cost of generic medications increase, 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 Dr. Maria Woodward. “A policy change, such as allowing Medicare to negotiate drug prices, would lead to more substantial savings.”

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