BLOG: ‘Fauxstasis’ muddies the waters, making deductible season even more confusing – Healio

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Biography/Disclosures

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Biography: White is an anterior segment surgeon and founder of SkyVision Centers in Westlake, Ohio.

Disclosures: White reports consulting for Aldeyra, Allergan, Avellino, Bausch + Lomb, Johnson & Johnson, Kala, Novartis, Orasis, Rendia, Santen, Sight Sciences, Sun and TearLab; speaking for Allergan, Kala, Novartis, Santen and Sun; and having ownership interest in Orasis.

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“I’ve already had four pharmacy requests to change patients to ‘Fauxstasis,’ and it costs the same as Restasis!” This is from Jasmine, SkyVision’s insurance expert.

Honestly, there’s simply no way you can’t convince me that there aren’t comedy writers moonlighting at health insurance and pharmacy benefit manager (PBM) offices, dreaming up ever more ludicrous frustrations to rain upon the heads of doctors and Jasmines. I mean, come on now, why do we have to even talk about changing people to a nonbranded cyclosporine A 0.05% in a non-Allergan emulsion if it costs our patients the same amount of money? Is it possible that Mylan has had kickbacks, er, rebates contracted with PBMs just sitting there waiting for the FDA approval to come through?

This is definitely not cricket.

Darrell E. White

And just to pour salt into our collective wounds, we get to confront this nonsense during the silly season when no one has spent their insurance deductible, and they face their annual sticker shock from exposure to the full retail price of their medicines. Just behind me, one of Jasmine’s colleagues spent 25 minutes on the phone working through immunomodulator math: one time deductible of $442 + (3 × 42) or 12 × $89. Over and over. And over. This is what PBMs have wrought. It’s just math, and yet I had a technician pulled from technician stuff to explain it to a patient who just can’t get past that $442 sticker shock. Add a little scalding water to that salt for your wound, too, in the form of prescription price hikes averaging 6.6% in the first month of 2022, according to The Wall Street Journal.

The silliness isn’t limited to Fauxstasis in the dry eye disease (DED) world. One of those comedy writers came up with a beauty. We had a new prescription for Restasis rejected, not in favor of Fauxstasis, but because we hadn’t demonstrated that the patient failed on the option favored by the formulary multidose Restasis. Which hasn’t been available for, what, 3 years now? How ridiculous is that? Seriously, someone has to explain this to me, otherwise I’m going with my underemployed comedy writers theory.

Hey, Mark Cuban! We have a generic in DED now. Wanna take a crack at our flavor of drug pricing madness?

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