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Madden-Sweeney Bill To Provide For Proper Treatment Of Glaucoma By Requiring Insurers To Cover Earlier Refills Of Eye Drops Now Law

Measure Aimed at Preventing Interruption In Treatment

TRENTON – Legislation sponsored by Senator Fred H. Madden and Senate President Steve Sweeney to provide for proper treatment of glaucoma, a disease that can lead to blindness if left untreated, by requiring that health insurers allow patients to receive early refills for medicated eye drops, was signed into law today.

The law (S-2166) aims to protect glaucoma patients against interruptions in treatment, which could potentially result in faster progression of the disease. The measure requires that in certain circumstances, health insurers that provide coverage for prescription eye drops allow early refills as long as the requested refill does not exceed the number of additional quantities indicated on the original prescription.

“Individuals suffering from glaucoma can have difficulty administering eye drops, which leads to unintentional waste and may cause patients to run out of medication before their prescription can be renewed,” said Madden (D-Camden/Gloucester). “By allowing patients to obtain early refills, this legislation will reduce the risk of interrupting treatment and ensure that patient health can no longer be jeopardized by insurance restrictions.”

It is estimated that more than 2.2 million Americans have glaucoma, a disease in which damage to the optic nerve leads to progressive, irreversible vision loss, according to the Glaucoma Research Foundation. Medicated eye drops are a common method of treatment used to manage glaucoma. However, a study published in the journal Ophthalmology found that glaucoma patients can have difficulty successfully administering medicated eye drops, often times using more at a time than prescribed. This can lead to patients running out of their medication before their insurance company allows for a refill of their monthly prescription, the lead researcher on the study told Reuters.

“Glaucoma patients should not have to put their health in danger because their insurance policy lacks flexibility,” said Sweeney (D-Gloucester/Cumberland/Salem). “This is a very serious disease, and insurance policies need to be more accommodating so that patients can get the medication they need and keep it from advancing.”

The Centers for Medicaid and Medicare Services in 2009 issued guidance on topical ophthalmics to prevent the unintended interruption of drug therapy in situations in which patients legitimately need earlier refills of prescription eye drops. While the guidance acknowledges that health insurers monitor appropriate refill periods as part of utilization management, the guidance also recognizes that the self-administration of prescription eye drops may involve some reasonable amount of waste and that earlier refills may be appropriate in some circumstances.

The legislation was approved by the Senate in March with a vote of 38-2, and passed the Assembly with a vote of 69-7 last December. The law will take effect in 90 days.

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