KNOXVILLE, Tenn. (WATE) — A retired nurse has depended on eye drops to keep her vision, but now her insurance company wants to drop one of the prescriptions. They want to switch to a generic brand of eye drops. But at 95 years of age, she’s asking why?
VJ takes the eye drops daily to keep her vision. She has Glaucoma, a serious eye disease that can cause vision loss and blindness. Those diagnosed with the disease, often take a group of eye drops in order to keep their vision.
To maintain her vision, VJ has been taking three medications for years. But her insurance provider, Clear Spring Health, recently informed her that it is dropping Alphagan, the medication used to lower pressure in the eyes of patients who have glaucoma.
“They just told my pharmacist they would not cover it. The insurance will not give any money towards it,” said VJ, who asked that we not use her last name.
She said her ophthalmologist prescribed the Alphagan.
“He put me on this medicine. He said do not let them change your medicine. You have got to get your pressure down and keep your pressure down. He said now you are getting older your age is against you,” said VJ.
If you have ever been to the eye doctor, as part of a complete eye exam, your ophthalmologist or optometrist will measure your eye pressure. When VJ’s pressure was checked years ago, the doctor told her there was a problem.
“She said you have got to get to somebody as soon as you can or you are going to be blind. She said your pressure is up to 22. She said it should not be over about 9 or 10. And you have got to get some medicine to get it down and now,” said VJ.
Now Clear Spring Health wants to drop Alphagan to a cheaper generic medication.
“I don’t want a substitute. Why would I when it’s saved my eyesight? Why would it at 95 years of age, it won’t be long that I live. Why would I want that?,” said VJ.
It’s likely she’ll receive lower-cost Brimonidine drops.
“The only thing I can say is it must be diluted down, or why would it be cheaper? Why do they want me on it, if it is not diluted down?,” said VJ.
WATE reached out to Clear Spring Health and asked why it’s changing her medication, there’s been no response. VJ said she asked her insurance company to reconsider, but the answer was no.
At the end of World War II, VJ was a nurse cadet for the US Army and enjoyed a long career as an RN. She’s familiar with the health system.
“[I’m afraid of] losing my eyesight. I want to see until I’m gone. I can’t take care of myself,” she said.
According to industry reports, companies that handle drug coverage for many commercial insurance plans over the last three years have announced dozens of brand-name drugs kicked off the formulary, or drug list. As a result, the patient is forced to switch to the generic.
Other times, there may not be a generic. Then, patients may have to jump through hoops to get back on their drug, or they may have to switch drugs, or insurance plans, all together.
VJ said she and her doctor are going to continue fighting her insurer to cover the eye drops that she’s depended on for years.