46 EyeWorld Asia-Pacific | September 2024 Coverage challenges and beyond Dr. Beckman said with all the products discussed in this article, he usually orders them in preference to what the insurance company will cover. “What every one of these has done is given me one more option because, in reality, they all work well for most people or at least some. There is a good chance that any of them will work well, and it’s not worth the fight with insurance initially. If I write for Xiidra and they get moved to Cequa by insurance, I’m not going to fight to get them on Xiidra when Cequa might work well for them and vice versa. I prefer to cross that bridge when they come back,” Dr. Beckman said. “The good news is a lot of these companies have excellent rebate programs. Sometimes we say, ‘This company has a coupon, saying pay no more than X. Are you willing to try that?’ If the patient says yes, we get it.” Looking forward, Dr. Rapuano said he’d like to see some of the challenges with early coverage become better addressed. He would like to see more options come to market that reduce compliance issues (fewer required doses, etc.). “I have some patients basically as if it’s a full-time job, and they’re doing something every hour. It’s unfortunate, but that’s what they need to make their eyes feel comfortable,” he said. About the Physicians Kenneth Beckman, MD | Director of Corneal Surgery, Comprehensive Eyecare of Central Ohio, Westerville, Ohio | kenbeckman22@aol.com Christopher Rapuano, MD | Chief of the Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania | cjrapuano@willseye.org Relevant Disclosures Beckman: AbbVie, Alcon, Bausch + Lomb, Tarsus, Sun Ophthalmics, Thea, Viatris Rapuano: Tarsus This article originally appeared in the June 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. I wish I had … Marjan Farid, MD, Cornea Editorial Board member, shared what she wishes she had: I wish I had an “all in one” diagnostic point-of-care test for dry eye disease that would give me information on multiple markers including osmolarity, MMP-9, lactoferrin, and others. CORNEA Tyrvaya (varenicline solution nasal spray, 0.03 mg, Viatris) Though approved in 2021, Dr. Beckman felt it was worth bringing up Tyrvaya in a discussion about recently approved ocular surface treatments. Unlike the drops discussed in this article, Tyrvaya delivers its active ingredient (varenicline) as a nasal spray, stimulating natural tear production. Dr. Beckman said Tyrvaya is a great option for contact lens wearers who don’t want to have to remove their lenses to administer drops and for patients who have difficulty putting in drops. “It’s just a different mechanism to stimulate tear production that works well,” he said. “One of the negatives is after you put it in some people start sneezing or they’ll complain that it hurts their throat. What we’ve found is a neat trick. It does not have to go way up in the nostril. It just needs to hit the nerve endings, which are lower. I instruct my patients to point the tip laterally, so it’s hitting the lateral wall of the nostril—not jamming it way up. Pinch the top of the nose to block it, and don’t inhale. Catch what runs out with a tissue. So they get the effect without the side effects. Since I’ve started telling patients to do this, it’s become much more tolerable. It works quickly. I’ve found with each use it makes the eyes run, and in my experience, those who tolerate it have a nice effect fairly early.” Dr. Rapuano finds Tyrvaya especially useful in patients who do want to add another topical mediation to their regimen.
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