contact lens care

Should We Dispense OTC Samples and Lens Care Kits?

BY MICHAEL A. WARD, MMSC, FAAO

What a silly question! Or is it? Many institutions are evaluating their policies about providing sample medications to patients under the auspices of ethical controls and removing potential conflicts of interest (COIs). Academic institutions have historically policed themselves through professional ethics standards and COI declarations and reviews. However, paranoia is flowing through the ethers of academic medicine, causing institutions to question all potential COI practices because of federal laws dealing with ‘fraud and abuse’ that threaten drug companies and providers who indulge in once-common marketing practices.

Sampling Pharmaceuticals

Consider: The pharmaceutical industry provides an estimated $12 billion worth of drug samples to healthcare professionals each year, more than what they spend on direct-to-consumer advertising. Approximately 60 percent of biomedical research and development is privately funded. Pharmaceutical companies provide more than half of the expense for formal CME programs.

Sample medications allow a doctor to assess a drug's efficacy and a patient's compatibility with the medication prior to purchasing a 90-day supply. It's argued that samples save money for some patients and particularly help those in need. It's also argued that pharmaceutical sampling promotes newer, more expensive medications in lieu of less expensive drugs, which may ultimately cost the patient more money than if they were not provided the new medication sample.

Then there are the questions of COIs that may arise between the prescriber and the pharmaceutical companies. And these COIs may also apply to over-the-counter (OTC) products such as artificial tears and even contact lens care solutions.

Lens Care Systems

Contact lens care systems are different. First, it's important to note that the U.S. Food and Drug Administration classifies contact lenses and lens care solutions as Class II medical devices, not as drugs. Second, dispensing contact lens care systems and instructions along with lenses is the standard of care in our industry.

Should we be paying for contact lens care starter kits? Maybe. I'm sure each practice could work out an attractive minimum price from most manufacturers. I don't see how that would address or eliminate any potential bias or conflict of interest; however, it would necessarily increase overhead costs. Practitioners choose a given care solution because of its compatibility with a given lens material, the product's safety and efficacy, prescribed wearing schedule and particular patient needs. It would be inappropriate to dispense multiple brands in an attempt to eliminate a perception of bias, and that would in fact create patient confusion and potential risk to ocular health.

Why would we question the appropriateness of dispensing lens care kits to patients? I recently contacted practitioners at multiple institutions to inquire about how they manage lens care kit distribution/sampling in their practices. All nine respondents stated that they still provide lens care kits to their patients, and this practice pattern is one that I will continue to promote. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #156.

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service.