Top 10 Tips for Reducing the Costs of your Glaucoma Medications

If you or someone in your family has glaucoma, the cost of the glaucoma eye drops may be a challenge each month, especially when considering that many people are also taking medications for other chronic diseases. Since glaucoma is generally a lifelong condition, it is essential to identify a long-term strategy for treatment, and financial burden is important to consider. This article provides some tips to help you reduce the financial burden of your glaucoma treatment.

1. Talk to Your Ophthalmologist
   
   Although you may feel hesitant to bring up cost considerations with your ophthalmologist, they are an essential team member in your care. They may be able to help you identify strategies to help reduce costs, and will be able to advise you on a myriad of potentially cost saving strategies, such as brand name vs. generic or alternative formulations. They may know about specific pharmacies or mail-in programs that lower costs. If you have insurance, your physician is your advocate in helping you obtain medications that may not be on the insurance plan’s formulary. If laser therapy or surgery are options to help reduce the need for medications, your ophthalmologist can counsel you on the pros and cons of these options (see tip #10).


2. Consider Generics, with Caveats
   
   Generic medications cost less than brand name medications, but are created to be the same as an existing brand name medication in dosage form, safety, strength, and quality. Generics have the same active ingredients as the brand name medications and should work the same way. The reason generics cost less is because the drug manufacturer does not need to repeat the animal and human clinical studies that were required of the brand name drug for safety and effectiveness. Furthermore, when multiple generic formulations of the same medication are available (this is true of many glaucoma drops), market competition typically drives down costs. However, recent glaucoma medication shortages have also driven up costs, so it is always worth checking the price of generic vs. brand name prior to picking up your prescription.
   
   While many patients’ glaucoma is well-controlled using generic medications, it is possible to have side effects using a particular generic that you did not have while using the brand name medication. This is because only the active ingredients have to be the same.
   
   A good source of generic glaucoma drops are large retailers such as Target, Walgreen’s, or Walmart, although this year Walmart does not cover glaucoma drops. These retailers have lists of generic medications they cover, updated yearly, and as one example you can often find generic timolol for $4 per month or $10 for a 90 day supply.


3. Shop Around
   
   The cost of a medication actually varies quite a bit in today’s marketplace from pharmacy to pharmacy, city to city, day to day. You can call around to your local pharmacies and find out the cost of your medication prior to filling it. Websites (and apps), such as GoodRx and BlinkHealth, allow you to search many of the pharmacies in a given area and lists the price of your medication, permitting you to find the lowest price.
   
   Drug manufacturers often have coupons, especially for new drugs. However, these coupons have somewhat of a catch, because ultimately the insurer will end up paying the cost difference. In order to account for this, the insurer may raise the co-pay on certain drugs or change their coverage limits to pass the cost back to the consumer. The drug manufacturer offers these coupons in order to encourage patients to continue using their brand name medication, and typically the coupons can only be used if you have commercial insurance.
   
   The type of pharmacy you shop at may also affect price. Independent pharmacies tend to have lower prices (and sometimes offer discounts if you pay cash), while larger retailers may have $4 generic programs (see tip #2). Also, many pharmacies such as Walgreen’s have prescription savings clubs although patients with Medicare or Medicaid do not qualify.


4. Talk to Your Pharmacist
   
   Your pharmacist is a very important resource for helping you identify ways to save on your prescription drug costs. In 2019, pharmacists can now tell you whether it is more or less expensive to pay your co-pay or just pay for the drug directly. Ask the pharmacist, “What will this cost me with my insurance? What is the cash price?” Your pharmacist can search for ways to lower your medication costs, and give you advice on your various options.


5. Split your Combo Eye Drop into Two Separate Drops
   
   Combination drops that contain two medications are often more expensive than each individual medication alone. This may be due to the fact that some are brand name (for example, Combigan®, Simbrinza®)*, or sometimes due to shortage of the generic (such as the recent shortage of dorzolamide/timolol (Cosopt®) that occurred). In either case, it may be less expensive to split the two components of the combo drop into two separate bottles. This may make it more challenging to take the medication, since it’s best to wait 5-10 minutes between drops, but it’s also possible that it will save a lot of money in the long run.  You can ask your provider to write on the prescription: “OK to separate into components if less expensive” as a note to the pharmacy, thereby giving you the option when you go to the drugstore.


6. Consider Alternative Sources for Your Glaucoma Eye Drops
   
   Although much more difficult to guarantee quality, it is possible to purchase glaucoma medications via online sources or abroad, such as from Canada. The FDA has guidelines on how to identify reputable online pharmacies. PharmacyChecker.com also allows one to search online for the best prices from online pharmacies, and also includes information about patient assistance programs (see tip #9)


7. Ask about a 90-Day Supply
   
   Sometimes a 90-day supply will be less expensive, whether because it means two less copays or a mail order service that has negotiated a better price for a 90-day supply. This is very useful when buying glaucoma medications that are used over the long term. Of course, you would only want to purchase a 90-day supply once you and your ophthalmologist have settled on your drug regimen.


8. Check out BenefitsCheckup.org
   
   Although there is no single clearinghouse for all potential medication benefits, BenefitsCheckup.org is hosted by the National Council on Aging and is a great way to find benefits in your area, tailored to you, and across all benefits. It includes benefits regarding medications, health care, income assistance, food and nutrition, housing and utilities, tax relief, veteran, and employment.


9. Look into Special Programs
   
   There are many special programs for those who cannot afford their prescription medications. These include state and local programs, Medicare, programs run by non-profit organizations, and patient assistance programs by the drug manufacturers. You will find some of these programs via BenefitsCheckup.org (see tip #8), and some of these programs have income eligibility requirements.
   
   Nonprofit organizations include Needy Meds, Partnership for Prescription Assistance, RxAssist, RxHope, and Rx Outreach. RxHope can help you find the information you need and file the paperwork to receive prescription medications. You can look up your medications directly on the Medicare website to find patient assistance programs, although it may not be the most up to date. Another strategy is to call the drug manufacturer or visit their website (Google the name of the manufacturer and “patient assistance program”), as many will have patient assistance programs and you may qualify.


10. Ask Your Ophthalmologist about Laser Treatment
    
    Studies have shown that laser treatment, such as selective laser trabeculoplasty, is more cost effective than using medications such as latanoprost. In addition, laser therapy is very appropriate as a first-line treatment, as demonstrated by the 2019 LiGHT (Laser in Glaucoma and ocular HyperTension) multicenter randomized controlled clinical trial in which patients either underwent laser treatment first or were treated with medications alone. Patients who underwent laser treatment had good clinical outcomes and lower costs, suggesting that laser is an appropriate first-line treatment for glaucoma and ocular hypertension (high eye pressure).

There are many approaches you can take to try to reduce your medication costs. Talk to your ophthalmologist and your pharmacist about additional strategies because you all belong on the same team with the goal of treating your glaucoma as effectively as possible.