Optometric Management - How to Maximize Prescription Authority
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`https://www.optometricmanagement.com/issues/2006/november-2006/...
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`Article
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`How to Maximize Prescription Authority
`Put your training into action with these proven steps.
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`November 1, 2006
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`1
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`prescription authority
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`MAXIMIZE Prescription Authority
`Here's how to put your training into action.
`MICHELLE BOYLES, Managing Editor
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`According to statistics from the 2004 AOA Scope of Practice Survey (the last year for which numbers are available),
`O.D.s diagnosed about 36% more patients with glaucoma in 2004 versus 2002, and 23% more with other anterior
`segment disorders. However, optometrists with appropriate prescribing authority in 2004 treated or co-managed 66% of
`the glaucoma patients they diagnosed and 85% of those diagnosed with anterior segment disorders. A recent survey by
`the National Board of Examiners in Optometry found that ocular disease treatment is an integral part of optometric
`practice and that prescribing topical medications, both legend and over-the-counter, is a primary treatment option. But
`only 13% of optometric examinations were disease-related.
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`As optometry moves to encompass the medical model and Baby Boomers age, you will find greater opportunities to
`manage patients who suffer from eye disease. Providing prescriptions will enhance patient care, boost your confidence
`and benefit your practice.
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`Therapeutics Most Prescribed By O.D.s by Category
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`Average number of prescriptions written in a six-month period.
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`Dry Eye
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`Antimicrobials
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`Allergy
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`Glaucoma
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`Anti-inflammatory/steroids
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`Vitamin
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`108
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`69
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`68
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`46
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`45
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`44
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`Optometric Management - How to Maximize Prescription Authority
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`https://www.optometricmanagement.com/issues/2006/november-2006/...
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`*Numbers from 2004 AOA Scope of Practice Survey.
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`Practice evolution
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`There are numerous reasons why it's important for optometry to increase prescriptions. On a professional level, it helps
`support expanded scope-of-practice. There are also some who posit that utilizing prescription authority is essential to
`optometry's evolution. "Any profession, or professional, who does not continue to expand and meet the challenges of
`new technologies will be driven to extinction," says Tom Annunziato, O.D., president of the Texas optometric
`Association. "Today's practices won't grow if they don't adopt the medical model," says optometrist Douglas DeVries of
`Sparks, Nev.
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`Writing prescriptions may also improve your standing with pharmaceutical representatives. Most of these companies
`track the number of prescriptions written for a given product, where the prescriptions are filled and who wrote the script.
`Some studies have shown a discrepancy in the number of prescriptions O.D.s report writing and the actual number of
`prescriptions attributed to them. But new regu- lations under HIPAA may change that. (See "Rx Tracking" on page 43.)
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`Over the counter products
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`It's important for patients to receive timely and accurate care. And writing a script for those conditions you know how to
`treat is important to your practice because it elevates you in the patient's eyes. Studies have shown that patients take a
`written prescription more seriously than a general recommendation. "The act of writing a prescription, whether for over-
`the-counter or prescription medications, is very powerful," says Carla Mack, O.D., Director of Clinics at the Ohio State
`University College of Optometry and author of OM's Coding column. "It's something physical ... that reinforces to the
`patient that you have the expertise and experience to care for that patient's needs," she says. So, don't just write
`prescriptions for medications that require them, write down the appropriate contact lens solution, dry eye treatment or
`nutritional supplement and hand it over to the patient.
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`Where Optometry is Restricted
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`Dots show in which states O.D.s can't prescribe certain medications.
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`STATE
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`Alaska
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`Arizona
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`California
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`Colorado
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`Delaware
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`GLAUCOMA
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`ORAL STEROIDS
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`ORAL PAIN
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`NARCOTICS
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`Eye Therapies Exhibit 2116, 2 of 7
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`Optometric Management - How to Maximize Prescription Authority
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`https://www.optometricmanagement.com/issues/2006/november-2006/...
`
`District of Columbia
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`Florida
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`Hawaii
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`Illinois
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`Indiana
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`Maine
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`Maryland
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`Massachusetts
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`Michigan
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`Minnesota
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`Mississippi
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`Nebraska
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`new Hampshire
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`New Mexico
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`New York
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`Ohio
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`Rhode Island
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`Texas
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`Washington
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`Wyoming
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`* Information derived from the American Optometric Association's State Government Relations Center.
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`"Without specific direction, a patient is bombarded with too many options when it comes to all over-the-counter
`medications," says Dr. Annunziato. "Without a professional's guidance, the patient is susceptible to the best-marketed
`products on the shelves."
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`Eye Therapies Exhibit 2116, 3 of 7
`Slayback v. Eye Therapies - IPR2022-00142
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`Optometric Management - How to Maximize Prescription Authority
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`https://www.optometricmanagement.com/issues/2006/november-2006/...
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`Most patients aren't familiar with the differences in OTC products. "I believe when you recommend an over-the- counter
`product, you should always prescribe," says Dr. DeVries, "If you just say, 'artificial tear' patients will buy whatever is
`cheapest and end up doing more damage than good."
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`Patients are also often forgetful. A written prescription will both remind them of the right product and reinforce the
`importance of the proper treatment.
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`Serving the Baby Boomers
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`The future will also bring more patients into your office with conditions that require medical management like surgery
`and age-related eye disease. Currently, most cataract patients are over the age of 60. In the next 15 years, 80 million
`Americans will reach the age of retirement. Age-related eye diseases are becoming more prevalent partly as the result
`of Americans' longer life span. "Think of the impact it would make if the doctor records on a prescription pad that he
`would like the patient to return in six months for re-evaluation of cataracts as compared to the office reception staff
`advising the patient call back in six months to schedule and appointment," Dr. Mack says.
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`Numerous ongoing studies will investigate other treatments for primary care patients. As these patients are likely to take
`systemic medications or supplements as well, it becomes imperative that optometrists understand the interaction
`between therapies and communicate them, so that patients avoid any dangerous interaction between drugs.
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`Treating glaucoma
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`The National Board of Examiners in Optometry's 2006 Practice of Optometry survey lists glaucoma medications at the
`top of those prescribed by O.D.s. In these cases, it often takes many attempts to find the right medication or
`combination to sufficiently lower a patient's IOP. Because glaucoma drops are expensive, many O.D.s give patients a
`sample to test efficacy and only write the script after they know the medication works for that patient. Dr. DeVries
`cautions against this, however. "Avoid going to the sample before writing the script," he says, "Then reappoint for follow-
`up to make sure the medication has adequately addressed the problem. The patient might need additional therapies."
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`Dr. Mack says, "We have the ability and legal authority to prescribe and care for many of these patient's acute and
`chronic needs. I believe we should prescribe for those conditions we feel comfortable with and have the legal authority
`to do so."
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`Contact lens care
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`"No one in this country is more qualified than an optometrist to counsel and direct a patient to the proper use of OTC
`contact lens solutions and rewetting drops," says Dr. Annunziato, "The Fusarium outbreak has taught us that lesson."
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`Newer silicone hydrogel lenses are not compatible with every care system and rewetting drop. Using the wrong product
`could damage not only a patient's eyes, but also the lenses themselves.
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`Prescribing Dietary Supplements
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`Eye Therapies Exhibit 2116, 4 of 7
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`Optometric Management - How to Maximize Prescription Authority
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`https://www.optometricmanagement.com/issues/2006/november-2006/...
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`Many patients today have shown a renewed interest in the role of dietary supplements. The Dietary Supplement Health and Education
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`Act (DSHEA) of 1994 defines a dietary supplement as a product taken by mouth that contains a dietary ingredient that may include
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`vitamins, minerals, herbs or other botanicals, amino acids and substances such as enzyme, organ tissues, glandulars and metabolites.
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`The DSHEA created a new regulatory framework for the safety and labeling of dietary supplements and place them in the general
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`category of foods, not drugs, so they do not require the approval of the U.S. Food and Drug Administration (FDA). Under this law,
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`manufacturers are responsible for determining that its supplements are safe and to substantiate any claims made about the product.
`Most Americans, however, don't know this. They see a bottle on the shelves of the local drug store that sometimes looks identical to
`over-the-counter medications and mistakenly believe the two products have undergone the same scrutiny. Prescribing the appropriate
`supplement will help patients avoid confusion in the aisles and keep them safe from dangerous side effects.
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`The Federal Trade Commission lists some common misconceptions among consumers:
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`BELIEF: The term "natural" means safe.
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`Truth: Although many supplements can be used safely by most people, others, including some herbal products, can be dangerous. Even
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`certain vitamins can be toxic at high doses.
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`BELIEF: Dietary supplements are safer than prescription drugs because they do not require a professional's supervision.
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`Truth: Studies have shown that some herbal products interact with drugs and can have a wide range of effects. For example, St. John's
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`Wort can lower the effects of certain HIV drugs and may interfere drugs used to treat depression.
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`Get involved
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`O.D.s who graduated from optometry school years ago may not feel comfortable prescribing newer medications. Dr.
`DeVries suggests starting with lower-morbidity disease entities such as allergy and chronic dry eye. "This is a great way
`to start to build a therapeutic subspecialty," he says. "Have an understanding of what acute or chronic disease
`processes you will feel most comfortable and have an interest in treating," Dr. Mack adds.
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`Dr. DeVries and Dr. Mack agree that continuing education seminars can help. "Continuing education will help bring you
`up-to-speed," says Dr. DeVries. "Go to major meetings such as the American Academy of Optometry and the American
`Optometric Association annual meetings and learn and communicate with your peers," says Dr. Mack, "Understand the
`current pharmaceuticals, their costs and side effects."
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`Dr. DeVries also suggests attending a specialty-oriented meeting. "Instead of an hour here or two hours there, you
`spend all day learning how to treat specific entity." Dr. Mack concurs, "Not a day goes by that we aren't receiving
`e-mails about these day or weekend courses that incorporate practice management as well," she says.
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`Educating staff and patients
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`You'll need to re-educate your staff and patients also. "Your staff has to buy into it," says Dr. DeVries.
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`"Relying on qualified ophthalmic technicians is crucial to a medical practice," says Dr. Annunziato. "Optometrists ... must
`learn to be data interpreters, rather than data gatherers."
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`He explains that 30 years ago, O.D.s could see 12 to 15 patients a day and make a reasonable living. Today, he says
`you need to see anywhere from 25 to 50 patients a day to maintain a standard practice. "A single practitioner gathering
`all his own data will not be able to meet this crushing demand," he says.
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`5 of 7
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`Eye Therapies Exhibit 2116, 5 of 7
`Slayback v. Eye Therapies - IPR2022-00142
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`Optometric Management - How to Maximize Prescription Authority
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`https://www.optometricmanagement.com/issues/2006/november-2006/...
`
`"Staff need to know that the doctor is going to be treating a wider range of patients," Dr. DeVries says. He suggests
`having a pharmaceutical representative host a "lunch and learn" with the staff.
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`Rx Tracking
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`Prescription tracking is the process through which pharmaceutical companies determine how many patients with a given condition you
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`see and what medications you tend to prescribe for them. The data is gathered through a pharmacy-reporting program and used to
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`plan marketing efforts. A 2003 study at the University of Missouri-St. Louis College of Optometry showed a significant difference in
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`between the numbers of O.D.-written prescriptions reported by pharmaceutical companies and the number self-reported by O.D.s. In
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`some cases, optometrists were under-credited by more than 90 prescriptions a month.
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`This could all change with the implementation of National Provider Identifier (NPI) numbers, a ten-digit number that will be used as a
`uniform means of health care provider identification. Under HIPAA, all public and private health insurance plans will have to recognize
`NPIs on electronically filed claims and many other transactions. HIPAA will not require the use of NPIs for prescriptions, but Medicare will
`require them for electronic prescriptions beginning in May 2007. And the DEA is strongly urging that NPIs be adopted as the generally-
`accepted means of prescriber identification for pharmaceutical prescriptions. It's uncertain when prescription-tracking services will begin
`using NPIs, but it may not be far off. You can apply for an NPI online, through the National Plan and Provider Enumeration System at
`https://nppes.cms.hhs.gov/NPPES/Welcome.do.
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`Annunziato T, Coble T. Appropriate use of pharmaceutical samples in the optometric practice. Optometry. 2006 Aug;77(8):405-12.
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`"Office staff often have lengthy conversation with your patients," says Dr. Mack, "They must internally promote all the
`services that you provide."
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`Marketing tools, such as on-hold messages, waiting room placards, etc., can alert patients to your new sub-specialty.
`"The timing of your message is critical," says Dr. Mack. "For example, right before allergy season, send a postcard,
`newsletter or e-newsletter out letting your patients know about the signs and symptoms of allergies and that you can
`treat them with the newest medications."
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`Best for the practice
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`Increasing your prescription authority will bring patients back to your office for continuing care and improve your
`reputation. "Your revenue will increase because the number of times a patient chooses to see you over time will
`increase as you monitor and treat their acute and chronic ocular diseases. The overall patient experience improves
`when they seek your care and you can provide that care and resolve the problem," says Dr. Mack.
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`Dr. DeVries sums it up, "My feeling is that we need to make our practice as healthy as we make our patients."
`Prescribing appropriately is a good start.
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`Eye Therapies Exhibit 2116, 6 of 7
`Slayback v. Eye Therapies - IPR2022-00142
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`Optometric Management - How to Maximize Prescription Authority
`
`https://www.optometricmanagement.com/issues/2006/november-2006/...
`
`Optometric Management, Issue: November 2006
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`Archives
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`Eye Therapies Exhibit 2116, 7 of 7
`Slayback v. Eye Therapies - IPR2022-00142
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