NEW YORK--(BUSINESS WIRE)--A just-released study reports that wider adoption of so-called “dropless” therapy in connection with cataract surgeries could save Medicare and Medicaid more than $7.1 billion over the next ten years. Patients could save an additional $1.4 billion for out of pocket costs for expensive pharmaceutical co-payments, and state governments could save $124 million in Medicaid payments during that time period.
Dropless therapy eliminates the requirement that patients self-administer expensive eye drops multiple times a day for several weeks after surgery. As a result, it also reduces the expensive insurance co-payments for eye drops currently paid by mostly-elderly patients who require cataract surgery, according to the nonprofit group Cataract Surgeons for Improved Eyecare (CSIE).
CSIE members, comprising cataract surgeons and ophthalmologists from throughout the U.S., frequently prefer dropless therapy for medical reasons. The alternative to dropless therapy is for patients to insert three different sets of eye drops – an antibiotic, a steroid, and a non-steroidal anti-inflammatory drug – into each affected eye several times a day for about a month following surgery. Because most cataract surgery patients are elderly, they often have difficulty complying with this regimen. As a result, the drugs frequently are not absorbed by the eye as required and serious vision and health complications can arise.
Currently, Medicare reimburses a majority of the cost of post-surgical eye drops. That cost averages $323 per eye. When further medical treatment is required due to patient non-compliance ̶ a common occurrence ̶ Medicare also pays the added cost of these treatments.
In dropless therapy, the cataract surgeon administers the same FDA-approved drugs as used in drop therapy, but does so immediately following surgery. As a result, in most cases, the patient does not require a post-surgical regimen of drops. The cost of dropless therapy is about 70% lower than drop therapy.
Yet Medicare currently pays nothing at all for dropless therapy, even though it does pay for the far more expensive drop therapy.
For nearly two years, cataract surgeons have been able to offer their patients the choice of dropless therapy or post-surgical drops. But recent Medicare and Medicaid reimbursement policy has stated not only that patients and physicians will receive no reimbursement for this new medical technology, but also that patients may not pay for it themselves.
Instead, Medicare takes the position that the cost of dropless therapy should be absorbed by the hospital or surgical center where the cataract surgery is performed. This has left only the hospitals, or the doctors themselves, as a source of payment. But because the hospitals and doctors pay nothing at all for drop therapy, which is covered by Medicare and the patients, there is currently a perverse disincentive to use dropless therapy. Not surprisingly, the lack of any funding for dropless therapy has seriously inhibited patient access and choice.
The CSIE-sponsored study examines what could happen to Medicare’s costs if dropless therapy were more widely adopted and patients were offered the freedom to choose dropless therapy.
“This study clearly illustrates that the wider availability of dropless therapy would benefit not only cataract patients, but also our national healthcare system,” said CSIE Executive Board member Dr. Eric Donnenfeld. “A change in policy to allow patient choice, either through Medicare reimbursement or at least the patients’ right to pay, would save the federal government billions. This is one of the most easy-to-read prescriptions the American public will ever see.”
Dr. Ahad Mahootchi, Medical Director of the Eye Clinic of Florida and a member of the CSIE Executive Board added, “Patients could win with a better treatment at a better cost. Taxpayers could win with lower costs. There’s no reason to maintain the status quo.” He went on to say, “Imagine denying a new vaccine or cancer drug that was both cheaper and better than current treatments. We need to fix our broken system which hurts patients and the taxpayer.”
The CSIE study was funded in part by a grant from Imprimis Pharmaceuticals (NASDAQ: IMMY), a maker of a compounded formulation of FDA-approved drugs that is most frequently used in dropless therapy.
“The current federal policy against reimbursement for dropless therapy has hampered our ability to deliver the best possible care to our patients,” said Dr. Richard Lindstrom, founder and attending surgeon with Minnesota Eye Consultants, and a member of the Imprimis board of directors. “It is one thing for Medicare not to reimburse for something. But going so far as to tell doctors who participate in Medicare that their patients can’t choose to pay either, makes this a Catch-22. This policy seriously interferes with the doctor’s duty to prescribe the best possible care, and the patient’s right to choose the best care.”
Some of the key findings in the study, conducted by the economic consulting firm of Andrew Chang & Co., Sacramento, California, include:
- Medicare and Medicaid will fund more than 38 million cataract surgeries over the next ten years. Medicare will pay for 96% of these surgeries.
- Post-surgery eye drop therapies currently cost Medicare an average of $323 per eye.
- Dropless therapy is priced at $100 –is about 70% lower than currently prescribed traditional drop therapy.
- Lower prescription costs, improved patient compliance, and superior patient experience are the three main reasons for the federal government to amend its payment policy to include dropless therapy.
- A change in the current policy could save Medicare and Medicaid an estimated $7.1 billion between 2016 and 2025.
- The same change in current CMS policy could enable patients to save $1.4 billion in out-of-pocket costs over the same period.
- Even if Medicare paid nothing but allowed cataract patients to pay the cost themselves, dropless therapy could cost patients less, because it would eliminate the need for high insurance co-pays that are required for the expensive postoperative drops.
CSIE members were motivated to sponsor the study because they believe the current Medicare policy is both harmful to patients (because it frequently denies them access to the best treatment) and needlessly costly to the health care system.
About CSIE
Cataract Surgeons for Improved Eyecare is a U.S. nonprofit comprised exclusively of leading cataract surgeons and ophthalmologists, and devoted to ensuring the highest quality of care for cataract patients. Visit us at www.ImprovedEyecare.org. The dropless economic study can be obtained from http://improvedeyecare.com/CSIE_Dropless_Economic_Study.pdf. For interviews with the study author or CSIE board members contact Paul Rabin at paul@pascalecommunications.com.