Parsing the Challenges of Reimbursement in the Glaucoma Space: Drug and Device Developers Address Elephant in the Room

SAN FRANCISCO – When it comes to securing reimbursement models, ophthalmic device and drug developers are facing mounting pressure. Payers are demanding more evidence on a device’s or drug’s safety, efficacy, how it will work in the real world, and its cost-effectiveness. Device and drug companies have to prove value while continuing to foster innovation.

At the Glaucoma 360 New Horizons Forum here earlier this month, panelists from leading device and drug companies explored reimbursement challenges from all sides of care – from patients paying more out of pocket to companies securing reimbursement for a new product.

Dealing with More Patients

As healthcare providers implement programs to hit payers’ value-based care targets, they’re subsequently faced with a growing number of patients. “Healthcare systems are not prepared on a global basis to handle the aging population,” said Nicholas Tarantino, OD, head of global clinical research science for Johnson & Johnson Surgical Vision.

To help keep those patients out of the doctor’s office, and thus help drive down healthcare costs, J&J Surgical Vision is investigating home-care diagnostics, Dr. Tarantino said. “There’s just going to be too many [glaucoma] patients to manage clinically,” he added. “How do we help in that process? Not by deteriorating care, but by improving care and holistically looking at how diagnostics and treatments can be coupled, whether they’re drops or stents.”

Omar Sadruddin, MD, global medical director for Santen’s surgical glaucoma business, said the company is addressing reimbursement challenges internationally. “We’re trying to assess what different countries need in terms of data, especially from a cost-efficient standpoint,” he explained. “In the US, we look at the balance between benefit-risk profile and the cost efficiencies that come with a device like the MicroShunt, which treats moderate to severe patients.”

Finding the Missing Link

Angelo Rago, global head of ophthalmic diagnostics for Carl Zeiss Meditec, said one of the missing links in addressing reimbursement challenges is between disease treatment and outcomes. “We have an enormous database that helps us inform our value proposition given the outcomes derived,” he said.

Adding to that, Jane Rady, SVP, corporate strategy and business development for Glaukos, said the company has been in a “leadership position” to create reimbursement in the MIGS space in the US as well as internationally. “Our commitment is this entire value proposition to the patient as well as the surgeon, and not just for product safety and efficacy, but outcomes management,” she said. “We support that with the clinical data to get that reimbursement, and to get it at a point that is attractive for the medical management of these patient populations.”

Despite its increasing complexity, negotiating with payers remains an inevitable part of doing business. “I don’t think there’s value in fighting the reimbursement process,” said Dr. Tarantino. “It’s going to happen. We’re going to be paid for value creation, not for creativity. We’re going to start to see more postmarket studies to show how the workflow has changed or how many more patients can be seen.”

What happens if device and drug developers don’t deliver those values in the glaucoma space? “The money is going to go away,” Dr. Tarantino added. “If [a provider] can see 18 patients instead of 10, that makes a huge difference to the system.”

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