Compounding Pharmacies in Eye Care


Making glaucoma medications easier and more affordable

Eyecare practitioners have several options for the drugs we prescribe to patients. First and generally most expensive, there are the branded, proprietary, patented drugs such as Xiidra, Rocklatan, and Vyzulta. Then there are generics—both branded generics and generics with equivalent active ingredients such as latanoprost, which are much less costly to insurance companies and patients.

“Most third-party payers are highly motivated to encourage the use of generic drugs, and overall in medicine about 80 percent of prescriptions are generic and growing in frequency of use every year,” wrote Richard L. Lindstrom, M.D., in Ocular Surgery News. “Ophthalmology is a bit of an outlier here, as we ophthalmologists prescribe more branded drugs than our primary care colleagues, but generic use dominates and is growing.”

Compounding allows doctors to customize medications for specific patient needs—a valuable and essential option in today’s “access market.”

There’s another option that plays an important role in ophthalmic care: compounding pharmacies. “Compounding is the art and science of creating personalized medicine for specific patient needs,” according to the Professional Compounding Centers of America.

Doctors often think of compounding as a means to obtain difficult formulations such as fortified vancomycin. But given today’s “access market” and sometimes very expensive medications, having a compounding option provides value and convenience for patients.

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A case for compounded glaucoma medications

For example, in my practice we’ve had times when we needed a branded medication and every option was beyond the patient’s financial means. We see this primarily with Medicare recipients where the discounts offered by the pharmaceutical companies don’t always apply.

Even for our cataract surgery patients, having multiple options is key. Avoiding callbacks is also very important to save critical staff time. In cases like these, the larger compounding entities such as ImprimisRx offer additional options to your patients.

Compounded glaucoma drops helped an elderly patient reduce his pressures as well as confusion over numerous medications and dosing schedules.

One of the best opportunities may be compounded glaucoma medications. A good example is one of my own patients, who was using Imprimis’ Simple Drops®—triple and quad drops. He originally presented more than two years ago at age 78 with pressures of 32 mmHg OD and 31 mmHg OS. He was on maximum therapy—three glaucoma medications—and his granddaughter explained that he often gets confused with so many different bottles, each with different dosing. In fact, he may well have been using his prostaglandin analogue medication two times per day and the others that should have been BID drops at a QD frequency.

I sorted out the medications and recommended an SLT. His pressures lowered to the low/mid 20’s. A nice improvement, but given his visual field defects, RNFL thickness, and low hysteresis, I knew his target pressure needed to be much lower. He had significant cataracts so it made sense to consider a MIGS at the time of cataract surgery. (As an aside, with new advancements such as the Hydrus microstent [Ivantis], we’re seeing significant IOP-lowering benefits for patients.) After these two surgical procedures (SLT and MIGS) his pressures were in the high teens (17-19 mmHg OU).

Over the next 12 months it seemed like visual field loss and mild OCT changes were still showing progression—although minimal or slowly. I decided to consider Imprimis’ triple and quad Simple Drops to help this patient with compliance and to reduce confusion about the various drops and dosing schedules.

He now takes the quad drop before bed (TIM-BRIM-DOR-LAT) and the triple drop (TIM-BRIM-DOR) in the morning. Instead of three or four bottles, he now has two. Instead of tracking which of the multiple bottles to use at what time, he has a morning and a night bottle. The 10ml size (triple drop) makes things much easier and more cost effective. The night bottle is 5ml, and the size difference actually helps him remember which one to use when.  

Benefits beyond cost and compliance

Other benefits are that these drops are preservative-free. Even the patient has noticed that his eyes feel better and he can see better. They were also less expensive than the previous three prescription glaucoma medications. But most importantly, since he started these drops his pressures have consistently been at 12 and 13 mmHg.

Imprimis’ compounded Simple Drops® for glaucoma clearly improved this patient’s quality of life, reduced confusion and stress, and I truly feel they prevented him from significant vision loss.

The views expressed above are of Dr. Karpecki and do not necessarily reflect those of Rendia.

To read more about trends in patient engagement and strategies to help patients navigate health care costs, check out Rendia’s other resources.

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