A Proposed Medicare Policy Would Tie Our Hands in the Fight Against Glaucoma

Chuck Williamson Jr

Glaucoma Today

As an ophthalmic practice administrator, I see every day what it takes to deliver the interventional glaucoma care necessary to preserve sight. It is not a simple cookie-cutter approach. A proposed Medicare policy would make it harder still, replacing physician judgment with a rigid, one-size-fits-all sequence that ignores how differently this disease behaves from patient to patient. What the LCDs Would Restrict Five Medicare Administrative Contractors (MACs) have similar Local Coverage Determinations (LCDs) in the proposal stage and available for comment through July 4. At issue is coverage of the intracameral travoprost implant (iDose TR, Glaukos). If the LCDs become finalized, Medicare would not cover the procedural pharmaceutical unless patients first fail both a trial of selective laser trabeculoplasty (SLT) and two topical medications. The LCD would also bar physicians from placing the implant during a MIGS procedure, whether that MIGS procedure is performed alone or in combination with cataract surgery. If finalized, the LCDs would take decision-making out of the hands of physicians and replace individualized judgment with a fixed treatment sequence applied to every patient. One Treatment Pathway Does Not Fit Every Patient Glaucoma is a heterogeneous disease. It presents and progresses differently in each patient, and physicians need a full range of options to treat each case individually.

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