Improving Patient Compliance With Compounded Glaucoma Medications
Reduce the number of drops by combining medications into one bottle.
By Steven R. Sarkisian Jr., MD
Glaucoma Physician spoke with Steven R. Sarkisian Jr., MD, about how using compounded medications can benefit both patients and providers.
Q: How do you frame the conversation around compounded medications when talking with colleagues?
A: When I give lectures about new modalities in glaucoma treatment and interventional glaucoma, I often start by talking about patient compliance with medications. Compliance is always the elephant in the room. We're delusional as healers if we think that there aren't issues with taking medications. The rate of true perfect compliance is probably less than 10%, particularly if patients are on more than one medicine. If patients took their drops perfectly, if the drops didn't have any cost, if they didn't have any side effects, if people didn't have any allergies to medications, and every patient was a responder, we really wouldn't be having this conversation. The bottom line is, even patients you think are taking their drops actually are not, or at least not with perfect compliance.
Every time you add a prescription, compliance drops precipitously. When you go from 1 to 2 medications, it drops precipitously. When you go from 2 to 3, it drops further. With the reality of poor compliance, compounded fixed-combination glaucoma medications have been a godsend to my patients. Two companies are doing this, ImprimisRx and OSRX. I have used both.
Q: What are the specific benefits to patients of using compounded medications?
A: There are benefits to both patient and practice of using compounded medications. Patients are often paying too much for their medications, particularly if they end up being on a Part D plan and falling into the donut hole. Compounded medications offer multiple medicines in one bottle, and patients don't have to use their insurance. They pay cash and it costs less than the copays would be for 3 to 4 bottles of drops. They also don’t have to worry about their insurance every time the company switches its formulary. With every formulary switch, there is a cascade of lost time and revenue with countless phone calls between pharmacies, doctors, and patients, and, worst of all, the risk that the patient might not get their medicine on time waiting for the logistics to work out.
Change starts with the eye doctors and their staff. We have to have this conversation with patients, because patients don’t know this is an option. I ask the patients, “How much are you paying for each medication?” “Most people have trouble remembering to take the second dose of the twice-a-day medicine. How often do you miss that dose?” I have been amazed at what patients tell me.
I often use the timolol 0.5%/brimonidine tartrate 0.2%/dorzolamide 2% (tim/brim/dor) fixed combination and the timolol 0.5%/brimonidine tartrate 0.2%/dorzolamide 2%/latanoprost 0.005% (tim/brim/dor/lat) fixed combination from OSRX. Patients get a morning bottle and an evening bottle, which should last 45 days, mailed to their house. Patients find the idea of a morning and evening bottle very appealing, considering that some might be on 4 different drops, 3 of which are twice a day and 1 of which is once a day. Patients get the schedule confused, and sometimes they have to wait 5 or even 10 minutes between drops, sometimes doing punctal occlusion after each one. Compounded medications free up their time. They love it! Usually, people don’t know what they want until you show it to them.
Our goal is to stop patients from going blind, so we need to be honest about what patients are willing and able to in terms of drop regimen. We're there to make a difference in patients’ lives with every tool that we can, and compounded medications have become really powerful tools to that end.