F E B R U A R U Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 1 0 5
would have to absorb the cost of the drug, a Medicare patient would
have to pay for it out of pocket or a commercially insured patient would
have to pay the full price up front and then be reimbursed the differ-
ence between the wholesale acquisition cost and what his carrier will
pay through the company's co-payment assistance program. Even
though Omidria, which is placed in the balanced saline solution (BSS)
for steady infusion into the eye throughout surgery, reduces complica-
tion rates, shortens surgical times and decreases the use of pupil-
expanding devices, how likely is any of that to happen?
"It's a good pharmacologic agent if the cost can be kept separate
from the standard cataract bundle," says Jeffrey Whitman, MD, presi-
dent and chief surgeon of the Key-Whitman Eye Center in Dallas,
Texas. "But in the current economic environment, there are more neg-
atives than positive associated with its use."
Because Omidria is administered through BSS, it might be useful in
keeping the pupil open during longer cases performed by less experi-
enced surgeons, adds Dr. Whitman.
"There's no doubt it helps maintain mydriasis, but not every patient
would need it for that purpose," says Steven Silverstein, MD, FASC, an
ophthalmic surgeon in Kansas City, Mo., and a consultant to Omeros.
CMS can statutorily only grant a drug pass-through status for a maxi-
mum of 3 years. Omeros, the drug's manufacturer, is lobbying Congress
to establish permanent separate reimbursement and to extend the pass-
through duration by 2 years. A pair of bills calls for Congress to extend
the pass-through duration from its current 3 to 5 years. If either bill
passes, CMS will continue to evaluate Omidria's utilization for possible
inclusion in the cataract bundled payment facilities receive for perform-
ing cataract cases on Medicare patients, says Dr. Silverstein.
— Daniel Cook
