Voyage LA Magazine Interview of Dr John W. Elman Optometrist
The link to the interview is
Voyage LA Magazine Interview of Dr John W. Elman Optometrist
I was interviewed for the June 12 2017 issue of Voyage LA Magazine. The magazine features articles about people and businesses in the Los Angeles area. It breaks down what's happening in various neighborhoods, and in the West LA section, they decided to do section on me, as an entrepreneur in Santa Monica. Besides talking about my early interest in optometry I am asked about where I think this sector of healthcare profession is headed, and I give my opinion about on line eye exams.
The link to the interview is
UPP Abandoned by Alcon, B + L, Johnson & Johnson--Game On
Alcon was the first manufacturer to implement unilateral pricing policies (UPP) with the introduction of DAILIES TOTAL1® Water Gradient Contact Lenses in 2013. It set a minimum price at which this product could be sold by contact lens retailers to the public. B+L, Johnson & Johnson and CooperVision put UPP in effect with the introduction of their new products. New products take time and money to develop, and the cost of this development often makes the cost of the new products greater than the old. The companies felt that eye care professionals would not try the new products unless they were assured that it would be profitable for the eye care professionals to prescribe the new products. If consumers had no economic incentive to purchase lenses from discount sources, they would be more likely to go to the eye care professional, the eye doctor, to get them, and also be examined for any adverse effects that the contact lenses might produce in the eyes.
1800Contacts influenced legislators in Utah to establish the Contact Lens Consumer Protection Act in that state which prohibited UPP.
By the beginning of 2017 most of the contact lenses which were released with UPP pricing were no longer UPP priced. The manufactures could see that it would not work if the prices of an online retailer in Utah was different than others across the country.. There were law suits and appeals against the controversial Utah legislation, but the apparent result is that UPP no longer exists for mot brands of contact lenses.
So how has this affected the eye care industry? Perhaps contact lens consumers are the winners. I don't see how 1800Contacts are the winners. They may be the most famous contact lens retailer, but they certainly aren't the cheapest or most conveinient.
When Bausch & Lomb introduced its monthly ULTRA® contact lenses in May, 2014 its UPP price was $60.00 per box of 6 lenses. That is the price eveyone sold it for, although it is possible retailers could charge more.
This week I dropped the price of a box of ULTRA® contact lenses to $55.00 per box, and there is an $80.00 in manufactures rebates on an annual supply of 4 boxes of 6, so that the annual supply of lenses (4 x $55.00 = $220.00) before the manufactue's rebate. In my office, after the rebate, a year supply of ULTRA® contact lenses is only $140, which is $35.00 per box.
1800Contacts sells a box of 6 ULTRA® contact lenses for $57.99 per box and advertises that ordering an annual supply of 4 boxes the cost after rebate is $42.99 per box, which is $7.99 per box more than I charge ($31.96 per year more than I charge). It should also be noted that I generally have these lenses in stock to pick up at my office, and offer free shippng on annual supply for people that perfer home shipping.
So who was the winner of all the law suits created by 1800contacts and the contact lens manufacture's?
It is obviously the contact lens consumer. Does 1800Contacts want to fight? Bring it on!
While manufactures such as Johnson and Johnson Acuvue have lowered their end of year 2016 rebates on annual and semi-annual supplies of contact lenses ALCON has announced an increase of rebates on its contact lenses--$200 for annual supply of Dailies AquaComfort Plus and Dailies Total 1, and with the $60.00 rebate on Annual supply of AirOptix series of monthly contact lenses there is a certificate to get 2 pair of free AirOptix color contact lenses and $50.00 in coupons for Alcon contact lens and eye care supplies--drops for dry eyes, allergies, and eye vitamins--some of the best deals we've seen on these products. Of course the free colored contact lenses are not available in powers for people who have astigmatism or need multifocal lenses. For people who need these kinds of corrections the free AirOptix Colors lenses may be more for cosmetic reasons than for vision correction...but Halloween is coming up! For a summary and links to current manufactures' contact lens rebates go to Rebates and Specials page on this website.
I have two stories to relate about my recent experience with online ordering of glasses and contact lenses:
Story #1: This week I saw a patient who came in to to get a new eyeglass prescription. The lenses, or at least the anti-reflection coating on the lenses, were starting to scratch off. It was a bit worse on one lens and he thought that was the reason he didn't see as well with that eye.
He not only had the glasses with him, but the two year old prescription from which the glasses were made. With the glasses on his vision was 20/20 with the left eye and 20/25 with the right. When I compared the glasses to the written prescription I found the axis of the astigmatism correction was about 5 degrees different between the written Rx and the glasses that were supposedly made from that Rx. The written Rx had an axis of 100 in the right eye; the axis measured in the right lens in the glasses was 95. The amount of astigmatism in the right eye was significant enough that the 5 degree difference between the written Rx and lens could make a difference in his vision.
When I asked the patient if he had gotten the glasses in the same place as his exam he replied that he hadn't--after he had examination from his optometrist he had ordered the glasses on line from Warby Parker.
My exam showed that the axis in that eye was 105. With that axis the patient's vision was 20/20. When I put my prescription in a trial frame and had the patient compare the vision with vision in his previous glasses the patient could see the one I had created was better.
Although a 5 degree axis discrepancy in axis isn't much, the fact that his axis was really 105, the 95 degree axis of his previous glasses meant the glasses were really 10 degrees off from his true astigmatism axis. The result was he was missing one line of acuity.
Story #2: Today there was a call that had been left on my office voice mail at 2:00 a.m. this morning. Then there was another call at 5:00 a.m. They were both from 1800Contacts, each for a different patient contact lens order. The first one was for a contact lens prescription that was expired. The second was for a different contact lens than was prescribed for the patient. It was asking for lenses in the same base curve and power I had prescribed for the patient, but it was for a different brand lens, that was cheaper and isn't even available in the base curve I prescribed. This vender usually sets their automated calls for Friday evening or hours when most doctors are closed. The reason for this is because the Fairness to Contact Lens Consumers Act (heavily paid for and supported by 1800Contacts) gives prescribers only 8 business hours to respond to a prescription request from a seller (exact wording is below):
"Prescriptions are verified automatically if the prescriber doesn’t respond to the seller’s verification request within “eight-business-hours.” A business hour is defined as one hour between 9 a.m. and 5 p.m., Monday through Friday, excluding federal holidays, in the prescriber’s time zone. If a seller determines that a particular prescriber has regular Saturday business hours, the seller also may count those Saturday hours as business hours under the Rule.
"When calculating “eight-business-hours,” begin the verification period the first business hour after the prescriber receives a complete verification request and end it eight-business-hours later. For example, if the prescriber receives a request at 10 a.m. Monday, the prescriber must respond by 10 a.m. Tuesday. If there’s no response, the seller can provide the contact lenses at
10:01 a.m. Tuesday. If the verification request is received at 10 p.m. Monday, the response would be due by 5 p.m. Tuesday. If there’s no response, the seller can provide the lenses at 5:01 p.m Tuesday."
The cryptic after hours requests are done in such a way to make it difficult for a prescriber to respond (the beginning of the request has a minute of unnecessary information and the name of the patient isn't announced umtill the end of message) so that the lenses can be sold to the consumer whether they are appropriate or not.
Prescribers like me and my colleagues take time to decide on the proper eye glass prescription and contact lens prescription and the materials appropriate for those prescriptions. When we order either glasses or contact lenses from our laboratories we check everything to make sure it is correct and verify lenses before dispensing them to patients. We recommend anti-reflection coatings combined with anti-scratch features that have a 2 years warranty against scratching. Because we order our products from reputable companies it usually is correct, but in the rare instants when either glasses or contact come in wrong we send the job back to be redone.
When you order on line who checks the work?
I often attend the Wednesday UCLA Stein Eye Institute Grand Rounds which has lectures on topics of interest to eye care professionals. The program on May 25, 2016 featured Kouros Nouri-Mahdave, MD speaking on Glaucoma in African Americans. A couple years ago I attended a Grand Rounds at Stein Eye Institute which featured Simon Law MD, PharmD. on how glaucoma affects people of various Asian races.
Although we Americans are taught by our Constitution that everyone has equal rights and should be treated equally, Mother Nature does not abide by this law.
These lectures inspired me to do some of my own research on the subject. Does glaucoma discriminate by race? And if it does, how does it discriminate?
We have known for years that glaucoma discriminates by age (although it is possible for babies to have glaucoma older people are more likely to develop glaucoma than younger people). The study of how glaucoma discriminates against different races is a more recent topic for research.
The doctors at the UCLA Stein Eye Institute have done a yet to be published 5 year study comparing 135 African American eyes to 135 Caucasian eyes to find not only the prevalence of glaucoma in each group, but how each group responds to various drug and surgical therapies.
There have been many studies showing racial differences in glaucoma, and the kind of glaucoma in different racial groups.
There are two main types of glaucoma, primary open angle glaucoma (POAG), and Primary angle-closure glaucoma (PACG). Primary open angle glaucoma (POAG) is more prevalent among people of European and African descent. A sub-group of primary open angle glaucoma is Normal Tension Glaucoma (NTG). NTG is form of glaucoma where optic nerve damage occurs even though pressures in the eye are not elevated (high eye pressure is the most significant risk factor for open angle glaucoma). A Japanese study found NTG accounted for 92 percent of open angle glaucoma cases in Japan.
In studies such as the Baltimore Eye Survey and the Barbados Eye Study, researchers have investigated how glaucoma affects different black populations.
Glaucoma occurs about five times more often in African Americans. Blindness from glaucoma is about six times more common. In addition to this higher frequency, glaucoma often occurs earlier in life in African Americans — on average, about 10 years earlier than in other ethnic populations. It urns out that medications that work in lowering the pressure in the white population are less effective in the black population.
A study conducted by a group from the Wilmer Eye Institute, Johns Hopkins University in residents over the age of 40 years residing in two counties of Southern Arizona indicated that open-angle glaucoma is the leading cause of blindness among Hispanics. This study, named Proyecto Ver, also reported that only 38% of Hispanics with glaucoma were aware of their disease.
The Los Angeles Latino Eye Study (LALES), another large prevalence study funded by the National Eye Institute reported an overall prevalence of open-angle glaucoma among Hispanics to be nearly five percent — similar to that found amongst African Americans.
The LALES, like Proyecto Ver reported that Hispanics over age 60 are at particularly high risk of glaucoma. Approximately 75% of Hispanics with glaucoma in LALES were not aware that they had the disease.
EyeCare America, a public service program of the Foundation of the American Academy of Ophthalmology, has highlighted the fact that most Hispanic Americans are unaware they are at higher risk for glaucoma than Caucasian Americans. The recently conducted National Americans Eye Health and Eye Disease Survey found that 76 percent of Hispanics did not know that their ethnicity was a risk factor for glaucoma.
Although Primary Angle Closure Glaucom (PACG) is less frequent among Caucasians and blacks it is the most common glaucoma among Chinese. For Chinese living in urban areas, the ratio of those with PACG to POAG is 2 to 1 — twice as many Chinese living in bigger cities have angle-closure glaucoma than the open angle type. PACG is a more aggressive form of glaucoma and accounts for 90 percent of all cases of blindness from glaucoma in China.
There is great racial diversity among Asian populations, and these differences are represented in the presentation of disease among Asian patients. Studies have found that South Asians, ethnic Chinese, and Intuit Eskimos are at significantly higher risk for angle-closure glaucoma, whereas a study of a population of Japanese patients found ACG incidence to be much lower than in their Asian counterparts, but as stated above, the Japanese have the higher percentage on Normal Tension Glaucoma (NTG).
A study published in the February 2009 Archives of Ophthalmology looked at a large Japanese American patient group in San Francisco and found that the proportion of patients with normal tension glaucoma was 4 times greater than those with high tension glaucoma.
Although it is not known why certain racial groups have a higher percentage of people with Primary Open Angle Glaucoma (POAG) there is a reason that primary angle-closure glaucoma is so much more prevalent in East Asian populations.
In Asian eyes, the iris (the colored part of the eye) attaches to the sclera (the eye’s white, protective covering) in such a way as to form an anatomically narrower angle with less trabecular meshwork exposed.
Angle-closure glaucoma occurs when the iris blocks the trabecular meshwork, the eye’s drainage system, which leads to increased intraocular pressure (IOP). The increased IOP eventually causes damage to the optic nerve, which transmits visual signals from the retina to the brain. If the angle closes suddenly, there can be a sharp increase in eye pressure. Symptoms of acute angle-closure may include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision.
This does not explain why Japanese have less Primary Angle-Closure Glaucoma than Chinese.
What we can derive from all this is that Glaucoma definitely discriminates among the races and everyone should have their eyes checked regularly by an optometrist or ophthalmologist because primary open angle glaucoma may not have any symptoms.
Many people have Health Savings Accounts (HSAs) or employer sponsored Flex Spending Accounts (FSAs) that have dollars in them that can be used for health services and materials.
FSAs can be used for extra pair of prescription glasses, or special purpose glasses that you have been putting off, polarized sunglasses or to stock up on contact lenses. Many of these type of accounts have to be used before the end of the year or the money is lost. In other words "Use it or lose it."
Sometimes people want glasses for a specific purpose--just to see in the far distance or just to use for reading, or just to use for computer or to read sheet music at the piano or on a music stand. Usually these special purpose glasses are for presbyopes--that is, people who are over 40 years old. Generally younger people can see at all distances with the same single vision lenses in their glasses. As people age, it takes a different power to see at different distance (see presbyopia). Presbyopes may do well with multifocal lenses such as bifocals or progressive lenses. The disadvantage of multifocal lenses is that the lenses are divided into different parts, and this division of the lenses limits the amount of area on lenses that is useable to use for different distances. This may bother the wearer who is moving around, who is walking and only wants the far distance corrected, or the wearer who is only using the glasses to view large computer monitors for a long period of thime. While most people find they adjust to multifocal lenses for these special purposes other people are bothered by the fact that they may have to move their head to get into the proper section of their lenses for the distances they are trying to see.
These people may be well served by having glasses for their specific purpose. It is important for patients to tell their optometrist their specific needs.
If reading glasses or computer glasses are made, patients need to indicate to their optometrist the exact distance where they read or the exact distance where their computer monitors are positioned. Each lens will have a certain range of use, or depth of field, but it is important for the optometrist to know what distance the patient likes to read or use a computer. These distances are not universal, and depend on many things, including arm length and habits that have developed by the patient. Does the patient generally hold reading material in his or her lap, or hold it 10 inches away? Is the patient generally using a laptop computer or a desktop? Not communicating these specific factors and needs to the eye doctor often will result in dissatisfaction with the specialty glasses prescribed and necessitate the glasses to be redone.
An experienced optometrist will know how to tailor special use glasses for each patient.
ICD-10 is the 10th revision of the International Classification of Diseases. ICD-10-CM is the United States version of this international classification of diseases. Implementation of ICD-10 is a very significant landmark for everyone involved with healthcare in the United States, especially with the complicated US healthcare insurance system. The changeover from ICD-9-CM to ICD-10-CM affects all healthcare providers, all hospitals, all health insurance companies, and US governmental agencies involved with healthcare.
Most of the world has been using ICD 10 for several years, but the United States is implementing its own version of it, ICD-10-CM, just as it has its own version of ICD-9, ICD-9-CM.
So how did we get here and where are we going? The history of the international classification of diseases is an interesting one.
An attempt at classifying diseases began with an international statistical congress in London in 1860. Florence Nightingale made a proposal that was to result in the development of the first model of systemic collection of hospital data. In 1893 French physician Jacques Bertillon introduced the Bertillon Classification of Causes of Death at a congress of the International Statistical Institute in Chicago.
A number of countries and cities adopted Bertillon's system, which was based on the principle of distinguishing between general diseases and those localized to a particular organ or anatomical site, as used by the City of Paris for classifying deaths. Subsequent revisions represented a synthesis of English, German, and Swiss classifications, expanding from the original 44 titles to 161 titles. In 1898, the American Public Health Association (APHA) recommended that the registrars of Canada, Mexico, and the United States also adopt it. The APHA also recommended revising the system every ten years to ensure the system remained current with medical practice advances. As a result, the first international conference to revise the International Classification of Causes of Death took place in 1900, with revisions occurring every ten years thereafter.
Prior to the sixth revision, responsibility for ICD revisions fell to the Mixed Commission, a group composed of representatives from the International Statistical Institute and the Health Organization of the League of Nations.
When diplomats met to form the United Nations in 1945, one of the things they discussed was setting up a global health organization.
WHO’s Constitution came into force on 7 April 1948 – a date we now celebrate every year as World Health Day. WHO also became the responsible body for ICD coding and their fist one, ICD 6, was a major expansion on the previous ones. Every 10 years there was an upgraded version,
The International Conference for the Ninth Revision of the International Classification of Diseases, convened by WHO, met in Geneva from 30 September to 6 October 1975. For the benefit of users wishing to produce statistics and indexes oriented towards medical care, the Ninth Revision included an optional alternative method of classifying diagnostic statements, including information about both an underlying general disease and a manifestation in a particular organ or site. International Classification of Diseases, Clinical Modification (ICD-9-CM) is an adaption created by the U.S. National Center for Health Statistics (NCHS) and used in assigning diagnostic and procedure codes associated with inpatient, outpatient, and physician office utilization in the United States. The ICD-9-CM is based on the ICD-9 but provides for additional morbidity detail. It was slightly updated annually on October 1, until this year, when ICD-10-CM will be implemented..
Work on ICD-10 began in 1983, and the new revision was endorsed by the Forty-third World Health Assembly in May 1990. The latest version came into use in WHO Member States starting in 1994. The classification system allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant expansion on the 17,000 codes available in ICD-9. The numeric coding of diseases is entirely different in ICD-10 than in ICD-9. Despite this, adoption was relatively swift in most of the world. Several materials were made available online by WHO to facilitate its use, including a manual, training guidelines, a browser, and files for download. Many countries adapted their own version of the international standard, such as the "ICD-10-AM" published in Australia in 1998 (also used in New Zealand), and the "ICD-10-CA" introduced in Canada in 2000.
Adoption of ICD-10-CM has been slow in the United States. Since 1979, the USA had required ICD-9-CM codes for Medicare and Medicaid claims, and most of the rest of the American medical industry followed suit.
On August 21, 2008, the US Department of Health and Human Services (HHS) proposed new code sets to be used for reporting diagnoses and procedures on health care transactions. Under the proposal, the ICD-9-CM code sets would be replaced with the ICD-10-CM code sets, effective October 1, 2013. On April 17, 2012 the Department of Health and Human Services (HHS) published a proposed rule that would delay, from October 1, 2013 to October 1, 2014, the compliance date for the ICD-10-CM and PCS. Once again, Congress delayed implementation date to October 1, 2015, after it was inserted into "Doc Fix" Bill without debate but over objections of many.
I have been a health care provider for over 40 years, and have been using the ICD-9 codes all those years. I know the most used codes in my industry in my head. Thank goodness for Google, to give health care professionals a place to reference the old codes with the new ones. It would have been much more difficult to institute the massive changes in disease coding prior to computers and the internet.
What I worry about is how the various health insurance companies will process claims with the new ICD-10 coding. The new coding is more specific than the old coding. For example, ICD-9 code for regular astigmatism is 367.21. There is no specific code for the right eye or the left eye. With ICD-10 regular astigmatism can be coded H52.211 (regular astigmatism right eye, H52.212 (regular astigmatism, left eye), H52.213 (regular astigmatism both eyes) or H52.219 (regular astigmatism unspecified eye). In order for a claim to be paid will insurance companies require the eye to be specified or will they allow us to submit a claim without specifying the eye, or will some insurance companies require eye specified and some not. There is already huge diversity in what insurance companies allow and what insurance companies do not allow, and sometimes it seems to be aimed at ways, or excuses, for the insurers not to pay a claim which , except for some technicality contrived by the insurance company, they should pay.
Much time and money will be spent this year while the healthcare industry sorts out how they will use the newly required ICD-10-CM coding, and the United States catches up with the rest of world, which has been using ICD-10 for the past 2 decades.
The Affordable Care Act (Obamacare) which is the basis for Covered California, greatly expanded the number of people covered under the state medical welfare program, Medicaid, or Medi-Cal, since it went into effect in 2014. Most people who have this insurance in California have signed up through a private insurance PPO.
We get calls almost daily from people who have signed up for Medi-Cal, but have no idea what they have signed up for or what their benefits are.
Medi-Cal has always paid providers much less for procedures than what the doctor's usual fees are from either private patients or other insurance. And it pays for less procedures.
For eye care coverage there are two main parts. One part is for the health of the eye--diseases and injuries--and the other part is for vision. The health part only pays if there is a disease code and does not have a restriction on frequency. The vision part will pay for an exam on an eye that has no disease code, but is limited in frequency to once in 24 months.
Since I am an optometrist most of the calls to our office inquire about vision. Here again, there are two main groups of people with different benefits--children (anyone under 21) or adults 21 and over.
Both children and adults can get a basic eye exam to determine the health of the eyes and the need for glasses once in 24 months. It does not cover a contact lens exam, nor contact lenses, and it does not cover glasses for an adult. Patients therefore have to pay for other services that are not part of the basic exam, such as contact lens exam, or Optos Retinal Exam.
For children, there are guidelines for basic glasses it will cover. It pays less than $20.00 for a frame, and pays optometrist a $22.00 a pair dispensing fee to order, inspect, and adjust clear prescription plastic eyeglass lenses that are manufactured in a prison in Chowchilla, California. Frequency of use for either exam or child's glasses is once in 24 months. No upgrades or frills are allowed on these lenses.
In order to be able to do examination and send a child's glasses to be made it is necessary to have an authorization from the private insurance company (usually VSP) that handles the claim, using the patient's valid Medi-Cal ID number.
Once ordered it takes about 2 weeks to get the child's glasses back from the prison lab.
An article in the September 1, 2014 journal Contact Lens Spectrum went into depth on the trend in the contact lens industry of UPP--Unilateral Pricing Policy. I would like to reiterate points in the article and comment on them, now that 1800Contacts is trying to have state laws changed to protect its business why I applaud manufacturers Johnson and Johnson (maker of Acuvue contact lenses), Bausch & Lomb, and Alcon, who realize that it is better if eye doctor's decide if contact lenses are appropriate for patients eyes rather than 1800Contacts.
Resale price maintenance (RPM), also known as retail price maintenance, is the practice whereby a manufacturer and its distributors agree that the distributors will sell the manufacturer’s product at certain prices (RPM), at or above a price floor (minimum RPM), or at or below a price ceiling (maximum RPM). If a reseller refuses to maintain prices, either openly or covertly (such as selling on the grey market), the manufacturer may stop doing business with it. This was per se illegal until 2007, when the U.S. Supreme Court deemed it legal in certain situations (e.g., pro-consumer situations) (Leegin Creative Leather Products Inc. v. PSKS Inc., 2007) .
The ongoing commoditization of contact lens sales has created an environment in which many eyc care professionals (ECPs), optometrists and ophthalmologists who are trained to fit contact lenses, consider contact lenses not appropriately profitable in comparison to other aspects of their practice. This has a potential impact on both patients and on ECPs. If appropriate profit motivation is taken out of the equation, there is significant potential for inhibition of innovation. Unless contact lenses can provide appropriate financial benefit to both the ECPs who fit them and, ultimately, to the manufacturers who conduct the research and development that create new contact lens materials and designs, there will be little motivation for innovation in the field.
Beyond the economic impact on contact lens innovation, there is evidence that the purchase of contact lenses outside of the fitting ECP’s practice can increase the risk of medical complications associated with contact lens wear. Fogel and Zidile (2008) published results of a survey of contact lens wearers indicating that consumers who purchased their contact lenses either online or at a vendor other than their ECP were significantly less likely to follow FDA-recommended contact lens care and wearing behaviors. Additionally, a study by Stapleton et al (2008) found that those individuals who purchased their contact lenses over the Internet were approximately 4.8 times at greater risk for developing microbial keratitis compared to patients who purchased their lenses at their ECP’s office. Potential reasons may be that patients who purchased lenses on the Internet may not have had appropriate and regular professional eye care, or they may perform contact lens care behaviors that put them at higher risk for infection.
As a practicing optometrist and contact lens fitter I, and my colleagues, have noted that online contact lens sellers, although they are legally bound to get a current contact prescription from the prescribing doctor, often go out of their way to pretend to get one, but never really make contact with the doctor's office in a way that the doctor can respond in a timely fashion. Either the online seller will have a long automated telephone call, which starts out give a lot of upfront useless information, such as the patient's address, reference number, before giving the patient's name, so you cannot even start retrieving information about the patient until the last part of the call, or they will send a fax when they know the office is closed, typically 6:00 p.m. on Friday, giving 8 hours to reply to message, knowing that the office will not be able to reply in time and filling the expired prescription anyway. People using online sellers can get contact lenses for years with an out dated prescription. It is obvious that online contact lens sellers do not care about the health of their customers eyes. They only care about selling the contact lenses before the doctor has a chance to stop the order.
Until recently, there was no RPM within the contact lens industry. With careful review of the law, it appears that a number of contact lens companies have boldly moved into this arena to protect their brands. In 2013, coinciding with the introduction of its Dailies Total1 daily disposable lens, Alcon put in place what the company defined as a UPP. This price policy initially was exclusively applicable only to Dailies Total1 contact lenses and not to any other of the company’s existing contact lens products. However, as stated previously, in 2014, Alcon extended its UPP to other new products. Under the UPP in the United States, Alcon will not sell (or permit its authorized distributors to sell) these specific contact lens products to customers who resell or advertise these products for sale to patients at less than the MRP set by Alcon. The company’s policy indicates that Alcon customers are free to sell the product at a price higher than the MRP; however, if they sell the product at a price lower than the MRP, Alcon will terminate the supply of the product to that customer for a period of one year.
Alcon says it has adopted this policy to encourage retailers to provide patients with a high level of personalized service from ECPs who have a deep understanding of the advanced new technology associated with these products. The idea is that premium products can prosper only if ECPs invest the time to learn about their benefits and to educate their patients about them. The UPP was designed to incentivize ECPs to this. Alcon states that the policy will benefit patients and help ensure that the company can continue to innovate and bring state-of-the-art products to market in the future (Alcon Unilateral Price Policy Customer FAQ Document, June 1, 2013). These statements are in line with the spirit of the U.S. Supreme Court’s ruling in the Leegin case mentioned previously.
In 2014, B+L became the next contact lens manufacturer to introduce a UPP when the company brought its new Ultra monthly disposable contact lens to the marketplace. B+L’s Ultra contact lens UPP states: “Bausch + Lomb is not making and will not make an agreement with any of its customers regarding the price at which such customer sells or advertises Bausch + Lomb Ultra® contact lenses. Rather, each customer is free to advertise or charge whatever price it wants, but should understand that Bausch + Lomb will cease to supply, and will prohibit its authorized distributors from supplying, Bausch + Lomb Ultra® contact lenses to any customer that resells or advertises Bausch + Lomb Ultra® contact lenses to the end consumer (e.g., patient) for sale at less than the MRP.” As to why the company adopted its pricing policy, B+L further states: “Bausch + Lomb Ultra® contact lenses are a significant advancement in contact lens technology. The full benefits of this advancement can only be realized through a deep understanding of the technology by eye care professionals (“ECP’s”) [sic], the provision of a high level of service by ECP’s based on that knowledge, education of consumers regarding the product and a continuing high level of customer service by Bausch + Lomb. The UPP is intended to (a) encourage ECP’s to invest the time to learn about the product and educate consumers, (b) support Bausch + Lomb Ultra® contact lenses as a premium offering and to enable Bausch + Lomb to continue to provide excellent customer service.”
Most recently, JJVCI applied a UPP to its existing Acuvue Oasys, 1-Day Acuvue Moist, and 1-Day Acuvue TruEye contact lens designs. JJVCI is the first company to apply a UPP to products that had previously been on the market and sold without a UPP. The company included the UPP as part of its “Enterprise Strategy,” which also included a new lens pricing program to the company’s resellers, new lens packaging, and the discontinuation of lens rebate programs. In a letter to eyecare professionals on June 24, 2014, Laura Angelini, president of Johnson & Johnson Vision Care – North America stated: “We believe the multifaceted nature of this new pricing strategy and the variety of elements that comprise the program will allow you to refocus the critical doctor/patient conversation on eye health and product performance, rather than cost. Also, by removing the complexity of rebates and building these savings into our new pricing, we believe we will be able to reach more patients with instant savings, while providing a simpler approach for everyone.”
The UPP prices in general are similar to the prices we were charging before UPP pricing. I have started keeping an inventory of 6 packs of certain popular UPP contact lenses. There is less incentive for patients to get contact lenses online and more incentive for patient's to get contact lenses from their doctors, who are in a position to see and know whether the contact lenses that were prescribed in a prior year are still the appropriate ones for the patient. If they are the appropriate contact lenses, the patient will get them for a fair price, and undoubtedly faster than he could from the online seller.
1800Contacts has submitted legislation in California Assembly Bill 789 which tries to reverse UPP in the state as it did in Utah.
I have written the following to my California representatives in Sacramento, before the vote on May 5, 2015:
I strongly OPPOSE Assembly Bill 789 which was proposed by the online contact lens seller 1800Contacts.
Resale price maintenance (RPM), is the practice whereby a manufacturer and its distributors agree that the distributors will sell the manufacturer’s product at certain prices (RPM). This was per se illegal until 2007, when the U.S. Supreme Court deemed it legal in certain situations (e.g., pro-consumer situations) (Leegin Creative Leather Products Inc. v. PSKS Inc., 2007) .
Last year, after realizing that it is better if Eye Care Professionals (ECPs), the eye doctor's who have been trained to fit contact lenses, should decide if contact lenses are appropriate for patient's eyes rather than 1800Contacts, contact lens manufactures Johnson and Johnson (maker of Acuvue contact lenses), Bausch & Lomb, and Alcon announced UPP (Unilateral Pricing Policy) on their new products.
On line sellers would often fill expired prescriptions and substitute lenses. There was growing evidence that the purchase of contact lenses outside of the fitting ECP’s practice can increase the risk of medical complications associated with contact lens wear. Fogel and Zidile (2008) published results of a survey of contact lens wearers indicating that consumers who purchased their contact lenses either online or at a vendor other than their ECP were significantly less likely to follow FDA-recommended contact lens care and wearing behaviors. Additionally, a study by Stapleton et al (2008) found that those individuals who purchased their contact lenses over the Internet were approximately 4.8 times at greater risk for developing microbial keratitis compared to patients who purchased their lenses at their ECP’s office.
Public safety should not be compromised to just improve the profits of 1800contacts. UPP is legal and good. Please vote against Assembly Bill 789.
Dr. John W. Elman is an optometrist in Santa Monica, California.