Darrell E. White, MD, is the founder of Skyvision Centers in Ohio. His blog for Ocular Surgery News will focus on issues related to dry eye disease.

BLOG: A new level of patient cost accounting

You will never hear me say that I’ve heard everything as an eye doctor. As in, “now I’ve heard everything.” Not from me. Uh-uh. Just today in the office, we received not one but two cakes from someone called a “cake ambassador.” Have you ever heard of a cake ambassador? Me either. I have no idea what a cake ambassador is or what they do, but judging from my first encounter today — two cakes out of nowhere! — I think I need to learn more about them.

Maybe get a new best friend who is a cake ambassador.

I also heard something entirely new from one of my dry eye disease patients, albeit on a very familiar topic. A patient who admits that the only thing that has ever made her eyes comfortable started complaining about the cost of her Xiidra (lifitegrast ophthalmic solution 5%, Novartis) before I even sat down. Her co-pay had been $5, but with her new insurance it was now going to be $40. So of course I automatically started my standard monthly cost calculator. Just before I launched into my explanation of how $40 per month is actually $20 after you factor in two doses per vial, she stopped me cold with this:

“My new insurance to cover medicine costs $90 per month, and the only medicine I take is Xiidra, so now it costs $130 per month.”

I wasn’t ready for that at all. How do I even begin to do that math? I mean, I have certainly (grudgingly) felt that it is the responsibility of DED doctors — probably all doctors — to discuss the cost of medications with patients. Not only that, we make all kinds of efforts to actually help patients afford their medicines, for DED and otherwise, through participation in preauthorization, using specialty pharmacies, etc. But I am drawing the line at any and all discussions about health insurance. SkyVision is on track for a 25% increase in health insurance premiums we pay for our census of 20. If I can’t even control what it costs to buy health insurance in my own practice, what chance do I have to make a meaningful difference in what my patients pay for theirs?

This is where I’m afraid I will have to draw the line. Discuss insurance premiums? Next, someone will ask me about the difference between Obamacare and Medicare for All. I just can’t. And don’t bother sending a cake ambassador to try and bribe me. You’ll just ruin a beautiful friendship before it has a chance to grow.


Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.