July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Non-Ophthalmic Provider Presciptions for Glaucoma Medications Under the Medicare Part D Program
Author Affiliations & Notes
  • Mark W Swanson
    Optometry, Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Footnotes
    Commercial Relationships   Mark Swanson, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1992. doi:
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      Mark W Swanson; Non-Ophthalmic Provider Presciptions for Glaucoma Medications Under the Medicare Part D Program. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1992.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : More than 98% of Americans over 65 are covered by Medicare insurance plans, of these more than 70% of recipients have prescription drug coverage under Medicare Part D plans. These include Part D stand alone and Part C plans. Every year since 2013 the Centers for Medicare and Medicaid Services has released utilization data on Medicare providers(Provider Utilization and Payment Data). This database includes information on number of claims filed by prescriber and type of medication as a dyad. Specialty assignment by the Center for Medicare and Medicaid Services (CMS) allows assessment by provider category. The goal was to determine the number of prescriptions by providers other than by ophthalmologists or optometrists.

Methods : Public use data from the 2015 Medicare Part D drug program were acquired from the Centers for Medicare and Medicaid Services. Claims data were searched for 20 topical glaucoma medications and oral acetazolamide. Descriptive statistics on medication utilization, total claims and provider type were generated by provider type. All analyses were done using SAS version 9.4.

Results : More than 19,000,000 claims for new or refills of glaucoma medications were filed by Medicare Part D recipients in 2015. As expected, ophthalmologists and optometrists provided the bulk of the claims 17,392,770(90%). However, more than 100 different types of health care providers had claims for glaucoma medications attributed to them, including dentists, chiropractors, social workers and most physician sub-specialties. General internal medicine and internists alone submitted 1,300,000 claims for glaucoma medications.

Conclusions : More than 10% of all claims for glaucoma medication under the Medicare Part D program are for prescriptions attributed to non-ophthalmic providers. This likely represents a combination of claims for long glaucoma medications among long term care residents, some claim misattribution as well as “helpful refills” by well-intentioned non-ophthalmic providers. The effect that this may have on disease follow-up and progression is unknown.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.


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