Madden/Sweeney Bill To Aid Glaucoma Patients By Requiring Insurers To Cover Earlier Refills of Medicated Eye Drops Clears Committee

Measure Aimed at Preventing Interruption In Treatment

TRENTON – Legislation sponsored by Senator Fred H. Madden and Senate President Steve Sweeney to allow for proper treatment of glaucoma, a disease that can lead to blindness if left untreated, by requiring that health insurers allow patients to receive early refills for medicated eye drops, was approved today by the Senate Commerce Committee.

The bill (S-2166) is intended to protect glaucoma patients against interruptions in treatment, which could potentially result in faster progression of the disease. The measure would require that in certain circumstances health insurers that provide coverage for prescription eye drops allow early refills as long as a refill exists on the original prescription.

“It has been found that individuals suffering with glaucoma can have difficulty administering eye drops, often times leading to unintentional waste of the medication. When this happens, patients can be left without the medication they need to treat the disease,” said Senator Madden (D-Camden/Gloucester). “It is important that we take action to ensure that patients are not at risk of experiencing interruptions in therapy because of a restriction placed on prescriptions by insurers. This will allow patients who need legitimately need earlier refills to access the treatment they need.”

It is estimated that over 2.2 million Americans have glaucoma, a disease in which damage to the optic nerve leads to progressive, irreversible vision loss, according to the Glaucoma Research Foundation. Medicated eye drops are a common method of treatment used to manage glaucoma. However, a study published in the journal Ophthalmology found that Glaucoma patients can have difficulty successfully administering medicated eye drops, often times using more at a time than prescribed. This can lead to patients running out of their medication before their insurance company allows for a refill of their monthly prescription, the lead researcher on the study told Reuters.

“This is a serious issue that affects glaucoma patients who as a result of insurance restrictions may be left without needed medication to stem the progression of the disease,” said Senator Sweeney (D-Gloucester/Cumberland/Salem). “Allowing patients the flexibility to refill prescriptions earlier will ensure that they get the medication they need to properly treat their condition, and to keep it from advancing.”

The Centers for Medicaid and Medicare Services in 2009 issued guidance on topical ophthalmics to prevent the unintended interruption of drug therapy in situations in which patients legitimately need earlier refills of prescription eye drops. While the guidance acknowledges that health insurers monitor appropriate refill periods as part of utilization management, the guidance also recognizes that the self-administration of prescription eye drops may involve some reasonable amount of waste and that earlier refills may be appropriate in some circumstances.

The measure would take effect 60 days after enactment. The committee approved the bill by a vote of 6-0. It now heads to the full Senate for consideration.

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