Living with a glaucoma diagnosis can be worrisome enough, but the cost of treatment may be even more challenging for patients with this condition, according to two recent studies.
The first research paper, published in the Journal of Glaucoma, found the incremental addition of IOP-lowering drops resulted in shorter-lasting benefits and higher costs with each additional agent, which suggests a need for new treatment options to improve disease control and reduce treatment burden.1 Allergan supported this study.
The investigators analyzed administrative claims data from a large database of insurance records that included records of diagnosed patients with initiated or intensified treatments of one to four topical glaucoma medications of a different drug class. They assessed treatment intensification rates and eye-related outpatient costs over a 24 month period.
Out of more than 48,000 patients, roughly 23,000 (47%), 16,000 (34%), 7,000 (15%) and 2,000 (5%) received a first, second, third or fourth medication class drop, respectively, as their first observed initial or intensified regimen.
At 12 months, approximately 8%, 12%, 17% and 23% of patients, respectively, received additional treatment, consisting of another drop or a laser or surgical glaucoma procedure. At 24 months, these percentages rose to 13%, 19%, 26% and 34%, respectively.
Also of note: eye-related outpatient costs over two years increased with each additional topical glaucoma medication: $1,610 ($3,460), $2,418 ($4,863), $2,872 ($5,110) and $3,751 ($6,608), respectively.
Slowing the escalation cycle of topical IOP-lowering therapy may offset the costs of multiple eye drops and delay the need for invasive laser and surgical procedures, the researchers noted in their paper.
“Early diagnosis and improved adherence could reduce the need for multiple drug therapy,” the investigators wrote in their paper. In addition, new treatment options to better control early disease may be needed to alleviate the long-term issues of unmanaged IOP, they added.
Brand Name Glaucoma Med Prices Spike
A second investigation, also published in the Journal of Glaucoma, found brand-name glaucoma medication prices vastly increased in the United States over the past seven years, despite a reduction in eye care providers’ tendency to prescribe these meds over generics. Between 2013 and 2019, the cost of brand name medications increased by 59%. On the other hand, generic medication prices decreased by 22% during the same time period, the researchers noted. They added that brand name drugs were 13- to 162-times more expensive than their generic counterparts.2
Some specific findings included:
- Price of brand name medications in 2019 ranged from $99.88 (Cosopt by Merck) to $460.75 (Timoptic 0.5% Ocudose drop by Bausch + Lomb). Conversely, generic medication prices in 2019 ranged from about $2 (timolol 0.5%) to roughly $59 (apraclonidine 0.5%).
- The mean price for brand name drugs was roughly $197 compared with $12 for generic drugs.
- When comparing brand name medication classes, beta blockers were the most expensive with a mean price of $313 per 5mL bottle, while combination drugs were the least expensive at about $146 per 5mL bottle.
- After adjusting for inflation, prices of brand name drugs increased, on average, by 59% from $124 in 2013 to about $197 in 2019, while generic drug costs decreased, on average, by 22% from about $16 in 2013 to approximately $12 in 2019.
- Brand name drug price increases ranged from 33% (Cosopt: $75 to $99) to 112% (Azopt 1% by Alcon: $70 to $148).
- Mean generic drug price changes ranged from a 2% increase (dorzolamide-timolol: $8.31 to $8.47) to a 64% decrease (levobunolol: $15.40 to $5).
All brand-name medication classes showed an increase in price during the study period. Carbonic anhydrase inhibitors represented the highest increase at 112%, while beta blockers had the lowest increase at a 44% rise in cost.
Looking at prescribing trends, eye care providers prescribed 25% fewer brand name medications in 2017 compared with 2013. This was largely due to more generic beta blocker prescriptions, mostly timolol, with only 1% of beta blockers prescribed being brand name, the researchers said in their paper.
A change in government policy allowing for Medicare medication price negotiations could greatly reduce health expenditure on glaucoma treatment, the researchers noted.
1. Patel AR, Schwart GF, Campbell JH, et al. Economic and clinical burden associated with intensification of glaucoma topical therapy: a US claims-based analysis. J Glaucoma. 2021;30:242-50.
2. Barayev E, Geffen N, Nahum Y, et al. Changes in prices and eye-care providers prescribing patterns of glaucoma medications in the United States between 2013 and 2019. J Glaucoma. October 29, 2020. [Epub ahead of print].