For many glaucoma patients, the challenge of long-term disease management begins not in the clinic but at the pharmacy counter, where the cost of medications can quietly determine whether prescribed therapy is followed at all. At the American Glaucoma Society’s annual meeting, a session on patient assistance programs focused on what clinicians need to know to help patients navigate the often-confusing system of pharmaceutical pricing.
Speaking on Friday at the meeting in Rancho Mirage, California, Lorraine M. Provencher, MD, a glaucoma specialist and refractive cataract surgeon at Vance Thompson Vision, outlined a practical framework for understanding patient assistance programs and counseling patients who struggle to afford their medications.
“We talk a lot about affordability,” Dr. Provencher said, “but not always about how to actually facilitate it.” She urged clinicians to think in terms of systems rather than single solutions, noting that no one pathway works for all patients.
Dr. Provencher began by reviewing manufacturer-sponsored assistance programs, such as copay cards and coupons. These programs can substantially reduce out-of-pocket costs for brand-name or specialty medications, but their reach is limited. “They’re typically restricted to patients with private or commercial insurance,” she explained, adding that they are not available to patients on Medicare or Medicaid and often include caps on duration or dollar amount. For eligible patients, however, they remain an important first-line option.
Discount platforms represent another increasingly common tool, particularly for patients who are underinsured or must pay high deductibles. These services, which are generally free and accessible via mobile apps, allow patients to compare cash prices across pharmacies. Their main limitation, Dr. Provencher noted, is that discounted purchases do not count toward deductibles or out-of-pocket maximums and cannot usually be combined with other assistance. Still, she described them as a useful “fast check” when a patient raises concerns about cost during a visit.
The growth of online and virtual pharmacies has further complicated the landscape. These companies lower overhead by operating without physical storefronts and offer medications at transparent markups, bypassing pharmacy benefit managers (PBMs), or “middlemen.” Dr. Provencher cautioned, however, that formulary limitations remain significant. “Just because a platform exists doesn’t mean it carries the medication you need,” she said. She also emphasized the importance of verifying availability and safety.
Compounding pharmacies can sometimes offer cost advantages or preservative-free formulations, particularly in complex cases, but they come with their own considerations. Oversight and accreditation vary, and clinicians should confirm whether a compounding pharmacy meets appropriate regulatory standards before recommending it. “[Compounded drugs] are not interchangeable with FDA-approved products,” Dr. Provencher said, noting the need for careful patient selection and counseling.
She also highlighted less commonly discussed resources, including pharmacies that specialize in accessible packaging for patients with low vision or physical disabilities. Options such as Braille labeling or prepackaged dosing systems can improve adherence for patients who might otherwise struggle with self-administration. In addition, she reminded clinicians that patients receiving Social Security Disability Insurance may become eligible for Medicare after a waiting period, which in some cases can be backdated.
Patients who cannot afford high drug prices sometimes ask questions about obtaining medications from overseas. Dr. Provencher explained that it is illegal for patients to import prescription drugs from overseas if the US Food and Drug Administration (FDA) has not approved them for the US market, but she noted that the FDA does not always enforce this prohibition for small quantities intended for personal use. There are other reasons that patients should be cautious about taking this route, she noted, saying, “There’s less oversight, and the risk of counterfeit or substandard products is real.”
Toward the end of her talk, Dr. Provencher broadened the discussion to include sustained drug delivery and procedural therapies as part of the affordability conversation. These approaches may reduce long-term reliance on topical medications and, in some cases, lower cumulative costs. “Sometimes procedural innovation may actually be more feasible and cost effective for patients,” she said.
Her central message was pragmatic: the system is too complex for clinicians to manage for their patients, but small structural changes within a practice can make a difference. She recommended designating a staff member as a de facto “drug access champion”—someone familiar with assistance programs and resources—rather than distributing the responsibility across multiple team members.
“We can’t do everything,” Dr. Provencher said, “but we can ask about affordability, then empower patients to take control of their care while helping them make safe, cost-conscious choices.” GP