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Novel Drug Delivery Systems Are Presenting a “Watershed Moment”

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Novel drug delivery methods are being developed to address the challenges many patients face with traditional eye drop therapy. Still, reimbursement issues for these new devices remain unsettled, noted Frances S. Mah, MD, during the American Academy of Ophthalmology’s 2019 annual meeting in San Francisco.

“For the past 70 years, we’ve been administering medications to the eye using eye drops,” said Dr. Mah, Director, Cornea and External Disease, and Co-Director, Refractive Surgery at Scripps Clinic, La Jolla, CA. But “this is a watershed moment as we transition to different types of delivery methods [to improve] out- comes, [offer] patient benefits, and [increase] compliance.” He mentioned two such systems designed to treat postoperative inflammation after cataract surgery:

• The dexamethasone ophthalmic insert releases a 0.4 mg dose for up to 30 days. It has the ability to taper doses. Fluorescein enables the clinician to visually monitor retention. The insert resorbs and exits the nasolacrimal system, thus avoiding the need for removal. If necessary, it can be removed by manual expression or saline irrigation.

• The dexamethasone intraocular extension uses proprietary technology to form a 2 mm sphere comprising active drug suspended in a delivery vehicle. This allows for a high initial release of dexamethasone, with sub- sequent rapid tapering.

Currently, both systems are reimbursed via CMS’s traditional pass-through provision, which encourages the diffusion of new technologies. Dr. Mah said this will likely be in place for the next 3 years. “Pass-through, by definition, means that it has to [comprise] a certain percentage of our cataract surgery reimbursement. The costs unfortunately are set at around $500. Government needs to work with industry to develop clever reimbursement strategies” to address this issue.



Mah F. Novel drug delivery methods: Dextenza and Dexycu. Presented at: AAO 2019 annual meeting; October 12-15, 2019; San Francisco, CA.

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