Q: I have a lot of patients asking me if I can “spare any samples” of brand-name glaucoma drugs. How do you handle that?

A: “If the patient specifically requests it, appears in dire need and is not able to get the medicine for a sight-threatening condition, then I will provide a sample,” says Robert Pinkert, OD, of Barnet Dulaney Perkins Eye Center in Phoenix.

But this is not what samples are really meant for, Dr. Pinkert admits. “We usually provide a free sample as an initial trial of the drug—especially in a chronic condition like glaucoma—rather than sending the patient to buy a $100 bottle to see if it works,” he says. “If it doesn’t work, we try something new.”

The price of the drug has everything to do with compliance.
Newly diagnosed patients often misunderstand this. “They may think, ‘You gave me the first bottle for free, why not just give me another one?’” Dr. Pinkert says.

In this case, “I generally say, ‘The samples are reserved for patients who need them on a trial basis. Your insurance should cover most of the cost of your prescription.’”

Keep in mind that the question “Do you have any samples?” is often the patient’s way of saying, “I can’t afford the medication you just prescribed.”

So if the patient’s insurance does not cover the drug—or the patient doesn’t have insurance—this should prompt you to help the patient get on a patient assistance program or to prescribe a less expensive generic drug, Dr. Pinkert says.

Patient assistance program. Each of the pharmaceutical companies that manufactures glaucoma medications—Alcon, Allergan, Merck and Pfizer—has an assistance program to help indigent patients afford the drugs they need. Usually, your office needs to be the advocate to get the patient on the program. (A list of these and other programs can be found on the Glaucoma Research Foundation’s website: www.glaucoma.org/treatment/financial-assistance-and-social-services.php.)

• Generic medication. “For most patients, I ask them if they would prefer a generic or a brand,” Dr. Pinkert says. “In most cases, they’re equivalent for garden-variety disorders.” (However, in the case of something like a sight-threatening ulcer, stick with the brand, he says. Also, some patients insist on a brand-name drug, and are willing to pay the difference.)

This begs the question: Are generic drugs equivalent to branded drugs? “The answer is, in many cases, they are,” Dr. Pinkert says. “But, in some cases, they’re not.”

‘This Little Bottle Costs HOW MUCH?!’
Patients are often surprised to find out that a tiny bottle of glaucoma drops can cost $100 or more. Help patients find the least expensive prescription in town by pointing them to a site like GoodRx.com.

Type in the name of the drug and your zip code, and up pops a list of nearby brick-and-mortar as well as mail-order/online pharmacies, along with how much each charges for that little drug bottle.
Generic ophthalmic solutions—such as generic latanoprost, for example—are expected to have both the same active and inactive ingredients, and in the same concentrations, as the brand-name counterpart. That’s OK if you’ve prescribed Xalatan (latanoprost, Pfizer) for your glaucoma patient. But what if you’ve prescribed Lumigan (bimatoprost, Allergan) or Travatan Z (travoprost, Alcon)?

“Are you really giving the patient the same drug?” Dr. Pinkert asks. “No, you’re not—but as a class they work very similarly in most patients. So, the clinical effect is about the same.”

In other words, the doctor must often weigh the clinical effectiveness vs. the cost, which is a major factor to compliance, Dr. Pinkert says. “And in chronic care, when the patient is going to be on the drops for many years and the cost is ongoing, we want the best outcome at the lowest cost with the fewest side effects.” So, for most patients, generics offer a fair compromise.