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Senate Bill 118 Sets It Sight on Improved Quality of Care

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On April 7, 2014, Governor Steve Beshear signed Senate Bill 118, an act related to prescription eye drops. The bill was heavily lobbied for by the Kentucky Academy of Eye Physicians and Surgeons (“the Academy”). The Academy’s mission is to provide convenient and quality eye care to the citizens of Kentucky and this bill accomplishes just that. Senate Bill 118 was introduced into the Senate on February 4, co-sponsored by Senators Julie Denton, Denise Harper Angel, and Reginald Thomas. The measure unanimously passed the Senate Banking and Insurance Committee and subsequently passed in the House with a vote of 98-1.

Beginning January 1, 2015, and applying to health benefit plans issued or renewed on or after January 1, 2015, patients who use prescription eye drops can now refill their prescription after 25 days, instead of the previous 30, if the practitioner notes on the prescription that additional quantities are needed. For a 90 day prescription, early refills are now permitted between 80 and 90 days. In addition, any health benefit plan that provides coverage for prescription eye drops must now provide coverage for one (1) additional bottle of prescription eye drops when: (1) the additional bottle is requested by the insured or prescribing practitioner at the time the original prescription is distributed to the insured, and (2) the prescribing practitioner indicates on the original prescription that such an additional bottle is needed by the insured for use in a day care center or school.

For individuals with chronic eye problems who use prescription drops, inadvertent waste of the precious drops can be a significant problem. Most health plans fail to provide an adequate volume because they do not account for any misapplication. If a drop misses the eye, it cannot be recovered. The slightest error in application means the drop is gone forever; it cannot be picked up off the floor and used again like a pill. Because of this, users may have to go for days without the medicine necessary to treat their condition.

This unavoidable problem especially affects children, who struggle with hand-eye coordination, and the elderly who experience limited range of motion and hand tremors. For glaucoma patients, an inadequate supply of drops is particularly troubling. Glaucoma treatment is directed at lowering eye pressure to prevent optic nerve damage and loss of vision. Eye drops are routinely glaucoma patients’ first line of defense. Consistent application is crucial; gaps in treatment can lead to vision loss and increase the risk of blindness. Without proper treatment patients may face much more costly and invasive intervention, such as surgery.

Now that patients will soon be able to obtain refills at the 25-day mark (and 80-day mark for a three-month supply), ophthalmologists can rest easier knowing there will not be detrimental lapses in eye drop usage. Though the new law does not become effective until January 2015, ophthalmologists should begin the discussion now with patients and explain the new 25 and 80-day time frames. Together, provider and patient should consider the need for extra drops. For younger patients, ophthalmologists should ask parents or caregivers whether younger patients could benefit from an extra bottle of drops at a day care center or school and so indicate this on the prescription. A bottle kept at a day care center or school may be refilled once every three months. Remember that it must be noted on the prescription that additional quantities are needed in every instance.

As more and more Americans gain access to health insurance coverage, it is important for those in the health care industry to take a step back and assess the scope of coverage that is actually being provided. Too often, health plans do not meet the needs of the insured. By taking note of patients’ everyday problems, like the inadvertent waste of drops, providers have a real opportunity to bring about positive change for their patients while improving the quality of care that they deliver. Sometimes, the smallest of modifications can make a big difference. The Academy saw a problem with prescription eye drop amounts and lobbied for a change. Thanks to the support of the legislators and Governor Beshear’s approval, Kentuckians with chronic eye conditions are now eyeing a better future.


Dr. Frank Burns is a general ophthalmologist who performs cataract, refractive, and laser eye surgery and cares for glaucoma patients both medially and surgically. Burns received his Doctor of Medicine from the University of Missouri-Columbia in 1986. He subsequently completed his internship in Internal Medicine, Research Fellowship in ophthalmology, and Residency in ophthalmology at the University of Louisville. His offices are located in Middletown and Brooks, Kentucky.