Q 1. Your organization is a/an: -- select state -- Respondent...
Transcript of Q 1. Your organization is a/an: -- select state -- Respondent...
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Name:
Company:
Title
Address
City/Town:
State: -- select state --
ZIP:
Email Address:
Phone Number:
Respondent Information*
Other (please specify)
Q 1. Your organization is a/an:
Administrative services organization (ASO)
Health care benefits purchasing coalition
Health insurance plan
Integrated health network
Managed care plan
Third party administrator (TPA)
PBM
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Other (please specify)
Q 2. Please indicate which job title best describes your position:
Corporate executive (CEO, President, COO, CFO)
Medical director
Pharmacy director
Formulary development strategist
Clinical pharmacist
Number of members
Q 3. Approximately what is the number of members enrolled in your organization's plans?
Q 4. Where do your organization's members reside? Please check all that apply
National
Northeast (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,Rhode Island, Vermont, Washington D.C.)
South (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee,Texas, Virginia, West Virginia)
Midwest (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, SouthDakota, Wisconsin,)
West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington,Wyoming)
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% Medicare Medicare Advantage – Prescription Drug (MA-PD)plans
% Medicare Prescription Drug Plans (PDP)
% Commercial Health Maintenance Organization (HMO) plans
% Commercial Preferred Provider Organization (PPO) plans
% Other commercial plans
% Affordable Care Act (ACA) Health Exchanges
% Federal employee plans
% Medicare / Medicaid Special Needs Plans (SNPs)
% Other Medicaid plans
% Other plans
Q 5. What percentage of these members are enrolled in:
Q 6. Do you include optometrists in your provider network? Please check all that apply
Yes, optometrists are included in our provider network as medical providers
Yes, optometrists are part of a visual plan eye care benefit
Yes, optometrists are prescribers in our provider network
We do not have a provider network
If you do not include optometrists in your provider network, why not?
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A great deal of
attention Neutral Less attention Not applicable
Conjunctivitis
Blepharitis (lid margin disease)
Diabetic retinopathy/Macular edema
Glaucoma
Keratoconjunctivitis sicca (dry eye)
Pre-operative/post surgical care
Uvetis
Wet macular degeneration
Q 7. How much attention does your organization pay to these eye conditions?
More attention Neutral Less attention Not applicable
We do notserve a
Medicarepopulation
Anticipate giving more attention to eye carecategory in the future?
Anticipate giving more attention to eye care for yourMedicare population?
Q 8. Does your organization:
Closely monitoring Neutral Less attention Not applicable
Conjunctivitis
Blepharitis (lid margin disease)
Diabetic retinopathy/Macular edema
Glaucoma
Keratoconjunctivitis sicca (dry eye)
Pre-operative/post-surgical care
Uvetis
Wet macular degeneration
Q 9. In your opinion, how closely will your organization be monitoring the following eye conditions forgrowth over the next 2 years?
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% Generic
% Preferred brand
% Specialty pharmacy
% Filled under the medical benefit
Q 10. Please note the approximate percentage of total prescriptions filled for all categories in 2015:
% Generic
% Preferred brand
% Specialty pharmacy
% Filled under the medical benefit
Q 11. Please note the approximate percentage of eye care prescriptions filled for all categories in 2015:
2017?
2020?
Q 12. What do you anticipate the proportion of total prescriptions will be for generics in:
2017?
2020?
Q 13. What do you anticipate the proportion of eye care prescriptions will be for generics in:
% in 2015
Anticipated % in 2017
Anticipated % in 2020
Q 14. For your Medicare population, approximately what percentage of the organization’s pharmacy budgetis spent on eye care?
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Does not apply
Data not available
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% in 2015
Anticipated % in 2017
Anticipated % in 2020
Q 15. For your commercial population, approximately what percentage of the organization’s pharmacybudget is spent on eye care?
-
Does not apply
Data not available
Other (please specify)
Q 16. How does your organization generally handle prescriptions for brands when a generic enters theclass? Please check all that apply
Move coverage of brand to a higher co-pay tier
Drop coverage of brand
Enforce generic substitution for all members at next prescription refill
Enforce generic substitution for new prescriptions, and allow patients already using the drug to continue current therapy
Other
%
Q 17. After one year of a generic introduction to a product category, approximately what percentage of yourplan members are using the generic?
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Pharmaceutical prescriptions (including eye drops)
Intraocular injections or implants (e.g. Lucentis®, Eylea®,Avastin®, Ozurdex®, Illuvien®)
Laser Treatments
Traditional surgeries
Microinvasive glaucoma surgery (MIGS)
Q 18. What percentage of covered eye care therapies are:
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Does not apply
Data not available
Pharmaceutical prescriptions (including eye drops)
Intraocular injections or implants
Laser Treatments
Traditional surgeries
Microinvasive glaucoma surgery (MIGS)
Q 19. What do you project the proportions will be 2 years from now?
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Does not apply
Data not available
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Strongly agree Agree Neutral DisagreeStronglydisagree
Generics are fully equivalent to the brand-namemedications in all classes where generics areavailable
The non-active ingredients in eye drops make nodifference in the effectiveness and tolerability of theproduct
Generic substitution is beneficial to patients
Prescribers know when it is in the best interest ofpatients to prescribe brand-name drugs, and whenit is best to prescribe generics
In classes where there is a generic available, it ispreferable to keep a branded product with adifferent active ingredient on formulary for thosewho are not responsive or can’t tolerate the generic
Offering several concentrations of activeingredients in eye drops assures that patientsreceive the minimum effective dose
Eye drops that combine 2 drugs commonlyprescribed together simplify dosing and help assurethat patients are compliant with necessarytherapies
Preservative-free formulations of eye drops arepreferable to ones containing preservatives
Q 20. Please state how strongly you agree or disagree with the following statements:
Very Important Important Neutral Less Important Not Important
Prevalence of disease / number of members withthe condition
Complexity of disease
Cost of treatment
New treatment options
Indications of improved patient outcomes from newtherapy options
Potential of inappropriate use
Unmet need
Utilization or expected utilization
Q 21. How important are the following factors when reviewing a therapeutic category for your organization?
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Very Important Important Neutral Less Important Not important
Acquisition cost
Assuring minimum effective dose
Clinical efficacy
Current market share
Duplication of existing treatment option
Ease of compliance and persistence
Ease of dosing
Following guidelines or standards of care
Generic available
Minimizing drug interactions
Packaging/quantity
Safety
Tolerability/adverse events
Total annual cost of treatment
Q 22. How do you rate the following factors when evaluating a new drug within a class?
Other (please specify)
Q 23. What factors cause your organization to initiate a category review? Please check all that apply
Addition of black box warning(s) on label
Addition of new indication(s) on label
FDA approval of new therapy
Generics entering category
New data about existing treatment options
Required annual review
Rise in cost of medications within category
Contract renewal
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Very
Valuable NeutralLess
Valuable Do not use N/A
Comparisons of surgeries and procedures by diagnosis
Comparisons of surgeries and/or procedures topharmacotherapy by diagnosis
Comparisons of branded to generic pharmacotherapy by FDA-labeled indication
Comparisons of branded pharmacotherapies by FDA-labeledindication
Q 24. What types of comparative effectiveness studies are of most value to your organization?
Q 25. Is there an exclusion policy for new drugs?
Yes
No
Not applicable
Commercial formulary and/or medical policy (months or n/a)
Medicare formulary and/or medical policy (months or n/a)
Q 26. Once a new therapy receives FDA approval, how quickly can it be accepted onto your organization’slargest:
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Strongly
agree Agree Neutral DisagreeStronglydisagree
I am aware of the Implantable and injectable sustained releasepharmaceuticals currently available in eye care
I am aware of the Implantable and injectable sustained releasepharmaceuticals in development in eye care
Implantable or injectable sustained release eye care products willimprove adherence
Implantable or injectable sustained release products will be avaluable addition to treatment options
Implantable or injectable sustained release products have thepotential to reduce the number of surgeries
These drug delivery devices are suitable for newly diagnosedpatients
Ophthalmologists are comfortable administering via intravitrealinjection
Ophthalmologists are comfortable administering via intraocularimplant
Q 27. Please let us know your opinion about implantable and injectable sustained release products bystating how strongly you agree or disagree with the following statements:
Q 28. Where in your organization is the decision made about an implantable drug therapy (such asOzurdex® or Iluvien®) for eye care?
Medical
Pharmacy
Q 29. Does your organization have pathways that physicians must follow before inserting these ocularimplants?
We have pathways and enforce them through a prior authorization protocol
We have pathways that are not enforced by prior authorizations
No
Not applicable
Other (please specify)
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Very tightlymanaged Tightly managed Neutral Lightly managed Open N/A
Currently
Expectation for 2018
Q 30. How tightly managed is your eye care category overall?
Very tightlymanaged
Tightlymanaged Neutral
Lightlymanaged Open N/A
Injectable anti-VEGFs approved by the FDA [e.g.Lucentis®/Eylea®]
Injectable anti-VEGFs used off label [e.g. Avastin®]
Short acting (3 to 6 month) intravitreal steroids [e.g.Ozurdex®]
Long acting (2-3 year) steroids [e.g. Iluvien®]
Laser Surgery
Q 31. Currently, how tightly managed are the following?
Very tightlymanaged Tightly managed Neutral Lightly managed Open N/A
Injectable anti-VEGFsapproved by the FDA[e.g. Lucentis®/Eylea®]
Injectable anti-VEGFsused off label [e.g.Avastin®]
Short acting (3 to 6month) intravitrealsteroids [e.g. Ozurdex®
Long acting (2-3 year)steroids [e.g. Iluvien®]
Laser Surgery
Q 32. In 2018, how will these be managed?
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Most More Neutral Less Least N/A
Injectable anti-VEGFs approved by the FDA [e.g.Lucentis®/Eylea®]
Injectable anti-VEGFs used off label [e.g. Avastin®]
Short acting (3 to 6 month) intravitreal steroids [e.g.Ozurdex®]
Long acting (2-3 year) steroids [e.g. Iluvien®]Noopinion/not sure
Laser Surgery
Please comment
Q 33. What is your perception of the efficacy of each of the following:
Most More Neutral Less Least N/A
Injectable anti-VEGFs approved by the FDA [e.g.Lucentis®/Eylea®]
Injectable anti-VEGFs used off label [e.g. Avastin®]
Short acting (3 to 6 month) intravitreal steroids [e.g.Ozurdex®]
Long acting (2-3 year) steroids [e.g. Iluvien®]Noopinion/not sure
Laser Surgery
Please comment
Q 34. What is your overall cost-benefit perception of each of the following:
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Please describe:
Q 35. What changes or trends do you believe may impact the importance of managing the intravitrealcategory in the next 2 years?
Change in treatment guidelines
Change in benefit design
Growth of value-based payment models
Increase in management
Newly approved therapies
Specialty drug expense
Other
Q 36. Does your organization have existing medical policy(s) in place for anti-VEGF and intravitrealsteroid products?
No policy
Retired policy
Category specific policy (e.g., intravitreal injectables)
Mechanism of Action (M0A) specific policy (e.g., anti-VEGFs, intravitreal steroids)
Product specific policy
Q 37. Since January 2015, did your plan experience any changes to medical coverage policy for intravitrealinjections? If so, what changes occurred? Please check all that apply:
No change
Added evidence to policy
Updated policy due to new indication
Changed requirements for use or Prior Authorization requirements
Created a new medical policy
Retired medical policy
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Q 38. What drove this change? Please check all that apply:
No change
FDA label update
More evidence available
New entry to category
Low or no inappropriate use
High rate of Prior Authorization (PA) approvals so no need for PA
No preferred product within category
Manage utilization through cost-share differentials
Other (please specify)
Q 39. When does your organization reach out to ophthalmic specialists for medical policy development orreview processes? Please check all that apply
When a specific question arises
To inform new product launches
To inform new indication launches
To inform medical policy decisions
To inform regular category review
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Strongly agree Agree Neutral DisagreeStronglydisagree
For the majority of glaucoma patients, lowerIntraocular Pressure (IOP) preserves field of vision
For glaucoma patients, medications are preferableto surgery if appropriate intraocular pressure ismaintained and patient tolerates treatment
For glaucoma patients, if a patient continues tohave elevated IOP when using generic treatments,it is preferable to switch the patient to a brandedpharmaceutical than to have surgery
I am aware of the new MIGS (microinvasiveglaucoma surgery) options for treating glaucoma
The current MIGS procedures appear to be apromising treatment option
The current MIGS procedures are highly likely tolower pharmacy costs for glaucoma patients
Q 40. Please state how strongly you agree or disagree with the following statements:
Q 41. When is it appropriate to approve a laser treatment or surgical procedure for a patient withglaucoma? Please check all that apply
When the patient has multiple medical conditions that preclude any additional pharmaceutical therapies
When the patient is compliant, but has failed to improve on several eye drop regimens
When the patient is unable to comply with eye drop regimens
As soon as the patient is diagnosed with glaucoma
Other (please specify)
Q 42. Do you have pathways that physicians must follow before surgery?
We have pathways and enforce them through a prior authorization protocol
We have pathways that are not enforced by prior authorization
No
Not applicable
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Strongly agree Agree Neutral DisagreeStronglydisagree
Dry eye disease is a chronic, progressive, diseasethat if left untreated leads to deterioration of thesurface of the eye
Appropriate treatment of dry eye has an enormousimpact on patient quality of life and ability tofunction
Dry eye is of growing concern to plan members
Dry eye is of growing concern to our organization
Q43. Please state how strongly you agree or disagree with the following statements about dry eye:
Q 44. Does your organization manage the utilization of any eye care medications?
Yes
No
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Most Effective Effective Neutral Less Effective Least Effective N/A
Claims system edit
Dose optimization
Generic substitution
Medication therapymanagement
OTC coverage
Period of use limits
Prescriberreimbursementdifferentials
Prescribing restricted tospecialist
Prior authorization
Quantity limits
Restricted pharmacynetwork
Selected brand-nameexclusions
Step therapy
Therapeutic interchange
Q 45. If you answered yes to the above: which utilization management techniques do you find mosteffective for eye care products?
Q 46. Which eye conditions have products requiring utilization management? Please check all that apply
Allergic conjunctivitis
Bacterial conjunctivitis
Diabetic retinopathy / Diabetic macular edema
Glaucoma
Keratoconjunctivitis sicca (Dry eye)
Lid margin disease (Blepharitis)
Pre- and post-ocular surgery
Uvetis
Wet eye macular degeneration
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Please describe any anticipated changes to the way you use or enforce utilization of your SP in the next few years:
Q 47. How does your organization use specialty pharmacy (SP) distribution of intravitreal injectables tophysicians? Please check all that apply:
We require use of SP
We encourage use SP
We do not use SP
Physicians able to buy and bill intravitreal injectables
Q 48. Does your organization consider difficulty in administering eye drops and possible drop wastagewhen making utilization management decisions?
Yes
No
Unsure
Other (please specify)
Q 49. In your opinion, how does patient adherence for eye drops differ from adherence for oralmedications?
Patients are more compliant with oral medications
No difference
Patients are more compliant with eye drops
Q 50. In your opinion, what percentage of patients has eye drops administered successfully into the eyemost of the time?
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Strongly agree Agree Neutral DisagreeStronglydisagree
Patients are very compliant with their eye dropregimens
Patients commonly believe they instilled their dropscorrectly, but in actuality it did not reach the eye
Difficulty with dispensing drops from the bottleappropriately can limit patient compliance
Patients are not very compliant with eye dropregimens
Better patient adherence can lead to fewercomplications and lower potential downstream cost
Eye care therapies that require dosing only once aday improve adherence
It is important to know whether patients areadherent
Q 51. Please state how strongly you agree or disagree with the following statements about compliance andadherence:
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Very Important Important Neutral Less Important Not important
Administrative costs
Disease severity
Ease of implementation
Minimizing hospitalizations
Lifetime cost of care
Manufacturer contractual incentives
Manufacturer program support
Patient education
Patient outcomes
Patient participation
Patient productivity
Patient quality of life
Pharmacy costs
Potential employer cost savings
Potential insurer cost savings
Potential patient cost savings
Risk of adverse events
Q 52. Please rate the importance of the following factors when developing adherence programs for eyecare:
1.
2.
3.
Q 53. Please name three national or regional organizations or associations (other than CMS) that have themost influence on your plan and your strategy in the eye care categories
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Very frequently Frequently Occasionally Infrequently Rarely
The approximate totalcost of the medicationsthey prescribe for apatient?
The approximate dollaramount that memberspersonally pay for eachof their prescribedmedications?
Other (please specify)
Q 54. In your opinion, how frequently do providers know:
Q 55. CMS recently proposed several initiatives to revise Part B product reimbursement. In your opinion,please rank which measures do you think will prove most effective in containing costs while maintaining orimproving quality:
Adjusting reimbursement of Part B products to ASP +2.5% plus a $16.80 flat fee
Copay waivers
Indication-specific pricing
Reference pricing
Risk sharing agreements
Strongly agree Agree Neutral DisagreeStronglydisagree
CMS’s new pilot program that reimburses providersof Class B medications at ASP + 2.5 % plus aservice fee of $16.80 is a fair reimbursement rate
The new CMS reimbursement program willincrease the percentage of generic medicationsadministered
The new CMS reimbursement program will favorsustained release products
Q 56. Please state how strongly you agree or disagree with the following statements about CMS pilotprograms:
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Please comment
Q 57. In your opinion, when will there begin to be a shortage of ophthalmologists?
Currently
Within the next 5 years
Within the next 10 years
There will not be a shortage of ophthalmologists
Please comment
Q 58. In your opinion, will optometrists become the “primary care physicians” for eye care:
Currently
Within the next 5 years
Within the next 10 years
Optometrists will not become the "primary care physicians" of eye care
Q 59. How do you think the new sustained release products, intraocular injectables/implants and MIGS willimpact the future of eye care?
Q 60. What challenges or opportunities do you see ahead for the eye care category?First Challenge
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Second Challenge
Third Challenge
Are you willing to be interviewed or participate in a future panel discussion concerning prescription drugbenefit design trends and issues?
Yes
No
Honorarium for this survey will be dispensed using the information supplied at the beginning of this surveyunless you request that it be sent to another address or donated to a designated charity in your name. Thecharity will need to provide you with the receipt for tax purposes.
Please donate the honorarium to a charity:
Please send the honorarium to an alternate address
Name:
Company:
Address:
Address 2:
City/Town:
State: -- select state --
ZIP:
Alternate address
Thank you for completing the managed care research.. We will send you a final copy of the report with your honoraria.
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* Respondent InformationQ 1. Your organization is a/an:Q 2. Please indicate which job title best describes your position:Q 3. Approximately what is the number of members enrolled in your organization's plans?Q 4. Where do your organization's members reside? Please check all that applyQ 5. What percentage of these members are enrolled in:Q 6. Do you include optometrists in your provider network? Please check all that applyIf you do not include optometrists in your provider network, why not?Q 7. How much attention does your organization pay to these eye conditions?Q 8. Does your organization:Q 9. In your opinion, how closely will your organization be monitoring the following eye conditions for growth over the next 2 years?Q 10. Please note the approximate percentage of total prescriptions filled for all categories in 2015:Q 11. Please note the approximate percentage of eye care prescriptions filled for all categories in 2015:Q 12. What do you anticipate the proportion of total prescriptions will be for generics in:Q 13. What do you anticipate the proportion of eye care prescriptions will be for generics in:Q 14. For your Medicare population, approximately what percentage of the organization’s pharmacy budget is spent on eye care?-Q 15. For your commercial population, approximately what percentage of the organization’s pharmacy budget is spent on eye care?-Q 16. How does your organization generally handle prescriptions for brands when a generic enters the class? Please check all that applyQ 17. After one year of a generic introduction to a product category, approximately what percentage of your plan members are using the generic?Q 18. What percentage of covered eye care therapies are:-Q 19. What do you project the proportions will be 2 years from now?-Q 20. Please state how strongly you agree or disagree with the following statements:Q 21. How important are the following factors when reviewing a therapeutic category for your organization?Q 22. How do you rate the following factors when evaluating a new drug within a class?Q 23. What factors cause your organization to initiate a category review? Please check all that applyQ 24. What types of comparative effectiveness studies are of most value to your organization?Q 25. Is there an exclusion policy for new drugs?Q 26. Once a new therapy receives FDA approval, how quickly can it be accepted onto your organization’s largest:Q 27. Please let us know your opinion about implantable and injectable sustained release products by stating how strongly you agree or disagree with the following statements:Q 28. Where in your organization is the decision made about an implantable drug therapy (such as Ozurdex® or Iluvien®) for eye care?Q 29. Does your organization have pathways that physicians must follow before inserting these ocular implants?Q 30. How tightly managed is your eye care category overall?Q 31. Currently, how tightly managed are the following?Q 32. In 2018, how will these be managed?Q 33. What is your perception of the efficacy of each of the following:Q 34. What is your overall cost-benefit perception of each of the following:Q 35. What changes or trends do you believe may impact the importance of managing the intravitreal category in the next 2 years?Q 36. Does your organization have existing medical policy(s) in place for anti-VEGF and intravitreal steroid products?Q 37. Since January 2015, did your plan experience any changes to medical coverage policy for intravitreal injections? If so, what changes occurred? Please check all that apply:Q 38. What drove this change? Please check all that apply:Q 39. When does your organization reach out to ophthalmic specialists for medical policy development or review processes? Please check all that applyQ 40. Please state how strongly you agree or disagree with the following statements:Q 41. When is it appropriate to approve a laser treatment or surgical procedure for a patient with glaucoma? Please check all that applyQ 42. Do you have pathways that physicians must follow before surgery?Q43. Please state how strongly you agree or disagree with the following statements about dry eye:Q 44. Does your organization manage the utilization of any eye care medications?Q 45. If you answered yes to the above: which utilization management techniques do you find most effective for eye care products?Q 46. Which eye conditions have products requiring utilization management? Please check all that applyQ 47. How does your organization use specialty pharmacy (SP) distribution of intravitreal injectables to physicians? Please check all that apply:Q 48. Does your organization consider difficulty in administering eye drops and possible drop wastage when making utilization management decisions?Q 49. In your opinion, how does patient adherence for eye drops differ from adherence for oral medications?Q 50. In your opinion, what percentage of patients has eye drops administered successfully into the eye most of the time?Q 51. Please state how strongly you agree or disagree with the following statements about compliance and adherence:Q 52. Please rate the importance of the following factors when developing adherence programs for eye care:Q 53. Please name three national or regional organizations or associations (other than CMS) that have the most influence on your plan and your strategy in the eye care categoriesQ 54. In your opinion, how frequently do providers know:Q 55. CMS recently proposed several initiatives to revise Part B product reimbursement. In your opinion, please rank which measures do you think will prove most effective in containing costs while maintaining or improving quality:Q 56. Please state how strongly you agree or disagree with the following statements about CMS pilot programs:Q 57. In your opinion, when will there begin to be a shortage of ophthalmologists?Q 58. In your opinion, will optometrists become the “primary care physicians” for eye care:Q 59. How do you think the new sustained release products, intraocular injectables/implants and MIGS will impact the future of eye care?Q 60. What challenges or opportunities do you see ahead for the eye care category? First ChallengeSecond ChallengeThird ChallengeAre you willing to be interviewed or participate in a future panel discussion concerning prescription drug benefit design trends and issues?Honorarium for this survey will be dispensed using the information supplied at the beginning of this survey unless you request that it be sent to another address or donated to a designated charity in your name. The charity will need to provide you with the receipt for tax purposes.Alternate address
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