As new therapy for glaucoma, allergy
Lee S. Peplinski, OD, FAAO: Drug samples are vitally important when starting any new chronic therapy. Conditions such as glaucoma, allergic eye disease, dry eyes and the like all lend themselves well to samples when a new drug is prescribed.
In these cases, I like to see if a product is producing the desired results before asking the patient to purchase a prescription. Given the cost of many of these new products, it is difficult to justify a $50 to $70 expense to the patient only to turn around at the next visit and tell him or her to discontinue its use because it did not work. Likewise, if a sample is given and the product proves effective, the manufacturer will more than make up for the cost of a sample in all of the refills of the product that the patient will likely use.
On the other hand, for acute conditions, it is more difficult to justify a sample, as the sample alone may “cure” the condition, resulting in no prescription ever being filled. In cases such as acute conditions or conjunctivitis, I will tend to provide a prescription rather than a sample. An exception to this is when the timeliness of starting the medication is critical and when waiting for the patient to get the prescription filled could significantly affect the condition. These examples might include infectious keratitis or corneal abrasion (for pain management).
When sampling, one important consideration is the size of the sample. A good clinical rule of thumb is that 5 cc will last 1 month at four drops per day. Many of the drug companies have decreased the size of their samples so that if the patient will be returning in 3 to 4 weeks, two samples may be needed to carry over him or her until the return visit.
Certainly, the more prescriptions an individual doctor is credited with, the more samples he or she is likely to obtain through the drug representatives. It may behoove younger practitioners to write more prescriptions so that they may get on the detail list for these representatives who will be more likely to share samples if they know prescriptions are to follow. In this regard, strength in numbers also proves true in group practices.
Regarding patients with financial difficulties, most of the drug companies have good patient assistance programs. However, when a patient cannot be covered through such a program, I would rather provide adequate samples to keep a condition such as glaucoma managed rather than having the patient lose vision because he or she could not afford the drops.
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- Lee S. Peplinski, OD, FAAO, is in private practice in Louisville, Ky. He can be reached at Bennett & Bloom Eye Centers, 4010 Dupont Circle, Ste. 380, Louisville, KY 40207; (502) 895-0040; fax: (502) 361-4488.
Essential for glaucoma care
Randall K. Thomas, OD: Drug samples are optional for many acute conditions (with some exceptions), but in glaucoma care they are essential. The monocular therapeutic trial is a time-honored, gold standard method for establishing appropriate therapy for patients with glaucoma.
The availability of samples allows such therapeutic maneuvers to proceed in a cost-effective manner. Can you imagine seeing a newly diagnosed primary open-angle glaucoma patient and writing him or her a prescription costing $30 to $60, only to have a “non-response” at the follow-up visit? This would represent poor care and probably result in a highly disgruntled patient. It should be evident that ample samples are a prerequisite for compassionate, cost-effective glaucoma care.
Like most doctors, I have a subset of patients who can ill-afford out-of-pocket expenses. This subset of patients significantly overlaps the subset of noncompliant patients. To maximally enhance their overall quality of life, I try to give them samples when possible. I am very grateful to have samples to share with these indigent patients. By the way, all pharmaceutical companies have indigent assistance programs. Simply contact any of these companies for information regarding courtesy supplies of drugs for specific patients.
For newly diagnosed patients with allergic conjunctivitis, I like to give the patient a sample and a written prescription for my drug of choice. I ask the patient to try the sample to ensure effectiveness, then to have the prescription filled once he or she has found the sample beneficial. Our office will readily authorize allergy prescription refills over the telephone.
There are times when all of us are occasionally called upon to see an emergency patient on a Sunday — a time when pharmacy services may be unavailable. Having samples available to initiate therapy until a prescription can be filled on the following Monday or Tuesday is essential in treating certain acute conditions on Sundays or holidays.
Drug samples are essential to my practice modus operandi, as they most likely are to all of my colleagues who provide medical therapeutic services as part of their practices. I am grateful that ophthalmic pharmaceutical companies recognize the value of sampling those OD offices that actively prescribe their products.
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- Randall K. Thomas, OD, FAAO, is a member of the Editorial Board of Primary Care Optometry News and is in private practice in Concord, N.C. He can be reached at 6017 Havencrest Ct., Concord, NC 28027; fax: (704) 792-1647; e-mail: email@example.com.
Chronic therapy, limited dose
Gary E. Oliver, OD, FAAO: When treating chronic ocular disease, such as dry eye syndrome, glaucoma or seasonal allergy, it is a good idea to sample the initial medication. For dry eye patients, sampling enables the practitioner to determine if preservative free, higher viscosity or gel formulations are necessary for proper management. When starting or adding a new drug in glaucoma therapy, sampling provides an opportunity to check for patient comfort, clinical efficacy (monocular trial) and potential adverse effects. The same would be true for anti-allergy medications.
It is also appropriate to sample a new drug that the practitioner has little or no experience prescribing. This would allow the practitioner to check the clinical efficacy and performance of a new drug before prescribing it on a regular basis.
Emergency situations would warrant a drug sample. This would include situations when you are seeing patients late at night or the patient has run out of medication and the pharmacy is closed. Sampling medications to start or continue treatment until the patient can get to his or her pharmacy would be appropriate.
In situations where a particular drug is needed for only a few doses on 1 day only, such as a nonsteroidal anti-inflammatory drug when treating a corneal abrasion. Prescriptions should be written if the drug is to be used on multiple days or for more frequent dosing.
Most patients have prescription drug plans, but some may not or have recently become unemployed. It would be reasonable to sample these patients for acute care if there is financial hardship. For chronic care medications, the initial medication could be sampled. Then check with the drug companies or other agencies regarding financial hardship programs.
In general, prescriptions should be written when treating most ocular disease conditions. While all health care practitioners may provide drug samples on various occasions, writing the prescription creates additional professional respect for the practitioner in the community and among other health care professionals, such as pharmacists. This can result in increased referrals to the practice from these individuals.
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- Gary E. Oliver, OD, FAAO, is clinical director for TLC Laser Eye Center in Plymouth Meeting, Pa. He can be reached there at 600 W. Germantown Pike, Suite 160, Plymouth Meeting, PA 19462; (610) 940-3937; fax: (610) 940-9566; e-mail: Gary.Oliver@tlcvision.com.
In very few instances
Laurie L. Sorrenson, OD, FAAO: In our office, there are very few times that we give full samples to patients. If treatment needs to be initiated right away, we will initiate therapy in the office with drops, call in the prescription to the local pharmacy and inform the patient that he or she needs to get the prescription filled immediately.
Patients with significant financial difficulties or who need chronic medications, such as glaucoma medications, are just about the only patients who will receive a full prescription sample. The doctors in our office realize the need for pharmaceutical research for all of our patients. Sampling extensively for short-term, acute ocular problems pulls dollars from the companies and hinders their ability to do this type of research.
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- Laurie L. Sorrenson, OD, FAAO, is in private practice in Austin, Texas. She can be reached at Lakeline Vision PC, 12233 620 North, Ste. 103, Austin, TX 78750; (512) 918-3937; fax: (512) 918-3260; e-mail: Sorrenson@attglobal.net.