Travatan® wins the prostaglandin wars

 

After much anticipation and delay, the decision is in, and travoprost 0.004% is the winner of the prostaglandin wars.

 

The new contract calls for travatan as the drug to prescribe for patients starting a prostaglandin.  The contract, however, allows for patients currently on xalatan or lumigan, the other two agents, to continue on these agents.

There are many issues that now are raised by the price to the VA, $7.50 per 2.5 ml bottle:

1) To convert or not to convert.  This is actually a multimillion-dollar question.  If conversion from one agent to another were totally equivalent in terms of intraocular pressure control and in terms of side effect profiles, this would be an easy decision. The reality is that we do not know the answer to these questions.  There, in fact, may be terrific pressure from the pharmacy to convert patients currently on xalatan and lumigan due to the cost savings to the pharmacy budget (travatan’s cost is approximately 33% of the other agents). 

However, what needs to be factored into the equation is the time, effort, and manpower required from our already heavily-burdened and backlogged clinics.  In the absence of good data to demonstrate that these agents are truly equivalent (IOP and side effects), a conversion would involve at least two visits, if everything goes well.  This does not factor in the education process, phone calls if any questions arise, and additional visits if side effects occur.

2) If it is too good to be true, it just may be.  The complete specifics of the contract have not been available.  We are being told that it is a one-year contract renewable for five years.  However, does that mean that the VA has the option to renew for the time period, or that Alcon has to agree to renew for the five years?  In other words, will this be up for bid again in one or two years?

Come to the AVAO Annual Meeting at the American Academy of Ophthalmology Meeting in Anaheim and hear the Alcon presentation of the contract specifics and have your questions answered.