Thursday, July 5, 2012

Generic Medicine and Cataract Surgery

"These eye drops are SO expensive."

"My insurance says I have to take this generic drop."

Every day our doctors, technicians, and surgical counselors hear some version of these two sentences. We hear it from almost everyone! It's funny how viewpoints have changed over the years. The fee that your insurance company pays a doctor and his staff to do everything that is necessary for cataract surgery in about 60% LESS than it was in the year 1990, and that's WITHOUT  taking into account any inflation. That means in 1990 the co-pay for cataract surgery was greater than what it costs in 2012 to buy the very best eyedrops that protect you from infection and inflammation.

Sometimes newer medicines really are better. They might work better, or have fewer side effects, or need to be taken less frequently. All of these things are important because you will have a better outcome from your cataract surgery if you take your medicine as our doctors have prescribed. Better vision. A lower risk of infection. Dramatically lower chances of swelling and inflammation. We have chosen the best medicines, the ones with the fewest side effects that are the easiest to take.

Here are two examples. SkyVision cataract patients receive a prescription for Besivance, a 4th generation antibiotic in its class. Many insurance companies try to make a switch to generic Cipro, a 3rd generation medicine that is available for perhaps 1/4 the cost. Sounds OK, right? It's only one previous generation? Well, good studies have shown that using a 3rd generation medicine instead of a 4th can increase the risk of infection by a factor of 10. 10 times the risk! Ciprofloxin must also be used 4 times each day and Besivance only twice which makes it easier to actually use the Besivance.

The other very important example is the Non-Steroidal Anti-inflammatory Drug or NSAID. If you don't take one you have a 10 times greater risk of vision threatening swelling in your retina. Both older, generic forms of NSAID's and newer branded ones reduce this risk. However, all of the older generic versions cause swelling and inflammation on the cornea, the front of the eye, in 3-4 out of 10 people. This results in pain, decreased vision, and the need to take more medicine for a longer period of time. On top of that, all of the generics HURT when you put them in, and you have to use them 4 times each day, and this makes people avoid using them at all.

You have two eyes. You will have cataract surgery on each eye once in your lifetime. Which is actually more expensive, the cost of the eyedrops your surgeon has chosen for you after careful studying of all the options, or the cost of using generic eyedrops that must be used more frequently, have more side effects, and may in some cases be less effective?

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