EyeWorld India March 2020 Issue

PHARMACEUTICALS 52 EWAP MARCH 2020 first-line agent, she said, but then is amenable to adding Rocklatan. “Instead of adding a beta blocker, I may be more prone to changing them over to Rocklatan instead, because it’s still at once-a-day dosing and you have two agents instead of adding another bottle of different medication,” Dr. Zhang said. In Dr. Trubnik’s view, one of the keys to success with Rocklatan is to start patients early. “When it’s added as a third or fourth drop, it gives the patient tremendous hyperemia,” she said. While the FDA study pegged 90% of hyperemia with Rocklatan as mild, Dr. Trubnik found that when it was added late, it wasn’t mild at all. “It was really quite significant and patients were terminating it because they were so unhappy with the physical appearance,” she said. Dr. Zhang, who said she tends to use Rocklatan early, finds that only a small portion of patients stop using this because of the hyperemia. “Sometimes that initial hyperemia is just due to the sensitivity to the agents and the eye gets a little bit better,” she said. Dr. Trubnik also tells patients about the possibility of red eye, explaining that it’s not an allergic reaction. Dr. Brubaker said he tells patients one of the mechanisms of Rocklatan is via its vasodilatory effect on the episcleral venous drainage. “I explain that often the cause of the red eye is that their existing conjunctival vessels are dilating to increase outflow of aqueous out of the eye,” Dr. Brubaker said. In addition to the red eye, another common side effect is verticillate that occur in about 15% of patients, he continued. “They have wispy looking deposits in the corneal epithelium,” Dr. Brubaker said. “I haven’t noticed that it causes any visual complaints. It’s more something that I notice.” After stopping the medication, this usually goes away in about 6–8 weeks. Weighing the components Physicians must sometimes decide whether to prescribe Rocklatan or offer latanoprost and netarsudil separately. “I would generally prefer to use the Rocklatan in every almost every situation, if I can, but because netarsudil has been out longer, we do run into some instances where netarsudil is covered and Rocklatan is not,” Dr. Brubaker said. In instances where someone is allergic to latanoprost, he also avoids Rocklatan. In addition, Rocklatan must be kept refrigerated once opened, while the individual components when bottled separately don’t have to be, Dr. Brubaker pointed out. If this is an issue for the patient, he prescribes the agents separately. Overall, Dr. Brubaker sees the Rocklatan as a nice addition that most patients have been happy with. “We often have other options if it doesn’t work, but it’s always nice to have the opportunity to improve compliance while also improving IOP,” he concluded. EWAP Editors’ note: Dr. Brubaker is affiliated with the Sacramento Eye Consultants, Sacramento, California. Dr. Huang is affiliated with the Glaucoma Institute of Northern New Jersey, Rochelle Park, New Jersey. Drs. Brubaker and Huang have relevant financial interests with Aerie Pharmaceuticals. Dr. Trubnik is affiliated with the Ophthalmic Consultants of Long Island, Long Island, New York. Dr. Zhang is clinical assistant professor of ophthalmology, University of Michigan, Ann Arbor, Michigan. Drs. Trubnik and Zhang declared no relevant financial interests. Reimbursement tips • Verify that Rocklatan is effective for the patient by first offering them a sample, Dr. Brubaker advised. • Once you’ve proven tolerability and efficacy, have the patient go to the pharmacy to determine copay. If it is high or if their insurance doesn’t cover Rocklatan, consider other approaches, such as use of company coupons, to get the cost down for patients, Dr. Brubaker recommended. • Prep your office to get prior authorizations and also prep the patient so that they don’t get frustrated if it is not be covered, Dr. Trubnik advised. • In cases where netarsudil and latanoprost are covered, document that they are doing well on the combination, Dr. Huang recommended, adding that you can include your reasoning for prescribing Rocklatan, such as compliance or decreasing medication burden. • Keep in mind that it can take time to figure out reimbursement issues, Dr. Brubaker stressed. During this period, offer patients another sample to help them get through the whole paperwork process.