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."
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."
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.
There used to be very good contact lens care products available a few years ago that are no longer available now. It has been very frustrating for me, a contact lens practioner, because products that I have recommended to patients for years, products that worked and which patients had no problems with, have either been discontinued or are difficult to get.
Since the advent of disposable contact lenses, which require less care when used as directed, the five manufactuers of contact lens solutions: Abbott- Advanced Medical Optics (AMO)(which took over the Allergan line of contact lens solutions) (http://www.amo-inc.com/site), Alcon(http://www.optifree.com/us/product_benefits.asp), Bausch and Lomb, and Ciba/Novartis (now Alcon), have tended to market only their multipurpose disinfecting solutions (MPDS): Abbot's RevitaLens OcuTec® AMO's COMPLETE® MPS EasyRub™, Alcon's OPTI-FREE® Express™, OPTI-FREE® RepleniSH™, OPTI-FREE® PureMoist® MPDS, or Opti-One® Multi-Purpose Solution, B&L's ReNu® Multiplus Multi-Purpose Solution and its newer Biotrue™, and CIBA's AQuify® 5 Minute Multi-Purpose Solution, respectively. (Bausch and Lomb's ReNu® with MoistureLoc® Multi-Purpose Solution was taken off the market in April, 2006 when it was implicated by the CDC in cases of fungal keratitis (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d410a1.htm?s_cid=mm55d410a1_x), and AMO's COMPLETE® Moisture PLUS™ was recalled May 25th, 2007, when it was implicated by the CDC in cases of Acanthamoeba keratitis). The function of these multipurpose contact lens solutions is to clean, disinfect, and keep moist (both in and out of the eye) any of the traditional hydrogel soft contact lenses, as well as the newer silicone hydrogel materials. With one day (single use) type of disposable contact lenses you don't have to use any solutions, other than the saline solution the sealed contact lens comes in. That is the primary advantage of one day disposable contact lenses. Theoretically, the wearer of a continuous wear disposable contact lens, if it didn't get dirty in the eye, could avoid using solutions, too. Exposure to infective agents in the environment (such as swimming, hot tubs, et al) while the lenses are worn could could cause these microorganisms to adhere to and multiply on a contact lens that is worn for an extended period of time, especially if one has a compromised immune system. A wearers lens handling is the source of most contamination and if your disposable contact lenses are to be taken out of the eye and reused then you must store them in some type of solution. A pure sterile saline solution could be used to store a sterile contact lens for a short time, but soft contact lenses, once they have been taken out of the sterile package in which they were shipped, are good media for growing bacteria, fungus, virus or other microbes. Solutions without disinfecting properties might be alright for a while, but if they have become contaminated from bacteria or other microbes on skin, tears, lens case, or anywhere else, these microbes can multiply in the pure saline in which the contact lens has been placed and infect the eye when the contact lens is later worn. From early on, methods of disinfecting contact lenses were developed that effectively killed pathogens. These methods included either heat, or some type of chemical for disinfection. Heat sometimes shortened the life of contact lenses and couldn't be used at all on some contact lens materials. Hydrogen peroxide was and still is a very effective disinfection method. In addition to disinfection, one or more methods of cleaning were developed to preserve contact lenses, surfactant cleaners that were rubbed on contact lens surfaces and enzyme cleaners which removed protein which had built up on contact lenses that had been worn for a period of time. So traditional contact lens care systems had separate steps and solutions, to disinfect, clean, and store contact lenses and these systems worked well.
"No Rub" Multipurpose Solutions
I always have to chuckle when I ask patients what contact lens solution they are using and their reply is, "No Rub." There never was a solution named "No Rub." But the four primary manufacturers of multipurpose solutions all prominently printed on the outside of the boxes and bottles of their products the words "No Rub." The illusion they wanted to portray is that one can be lazy about contact lens care without risk, when in reality this is not the case. Multipurpose contact lens solutions made by the four major contact lens solution manufacturers probably work alright for most people wearing disposable contact lenses. The only contact storage products given to America's contact lens fitters as samples are the multipurpose solutions by the four manufacturers. In turn, they are usually the only contact lens storage products given to new contact lens patients. Although the manufacturer of each of these products used to tout its product as being better than the others because of its ability to keep contact lenses moist while in the eye, it turned out that the moisturizing agents in B & L's ReNu® with MoistureLoc® and AMO's COMPLETE® Moisture PLUS™ is what apparently attracted microorganisms (fungus and amoeba, respectively) causing corneal infections that led to the recall of these products. I believe Alcon was the first of the multipurpose solution makers to print "No Rub" on its boxes of OPTI-FREE® multipurpose solution, and the other three manufacturers soon started printing that on their boxes too. Personally, I have long felt that rubbing a cleaner on the contact lens surface, and then rinsing the debris off before before storing, cleans the lens better than just taking the lens out of the eye and storing in the solution without rubbing it. I am sure laboratory tests will confirm that. Rubbing is a good thing, not a bad thing, even if it takes a few seconds to do it. Lately contact lens solution makers are starting to realize the error in their ways in playing into the "No Rub" myth by admitting that rubbing helps clean contact lenses and AMO even has put rub into the brand name of its 2007 replacement product by calling it AMO COMPLETE® MPS EasyRub™. I guess rubbing is not so difficult after all. But the "No Rub" designation is not my main gripe. Besides the "No Rub" idea, there are two other things I don't like about multipurpose solutions: First, even though multipurpose solutions have cleaning and disinfecting agents in them I believe that multipurpose solutions neither clean nor disinfect as well as solutions dedicated to that purpose. Second, people can be, and many are, allergic to the agents in the multipurpose solutions that are used for disinfection and cleaning. Dr. Gary Andrasko studied the toxicity affects of various multipurpose solutions by soaking contact lenses made of the newest contact lens materials in these solutions and then placing the contact lenses on the eyes of volunteer subjects. The toxicity effect was measured by the amount of corneal staining produced by various lens/solution combinations. The results are were tabulated on a grid and published on the web at www.staininggrid.com.
The Good Ol' Days of AOSEPT®
To me, the gold standard of contact lens care systems, the one I traditionally used for people using non-disposable premium soft contact lenses, is the Ciba AOSEPT® system. A contact lens system is not just a single solution but several products and steps, used together to achieve the goal of cleaning and disinfecting contact lenses, without bothering the eye in any way. The original AOSEPT® system consists of: 1) Removing contact lenses from eyes and rubbing lens surfaces with a daily cleaner (Miraflow®), 2)rinsing cleaner off lenses with sterile non-preserved saline solution (generally Softwear® Saline), 3)placing contact lenses in a special case that has a disc (AOdisc®) at the bottom 4) filling the case up to the line with AOSEPT® solution (a 3 % hydrogen peroxide premixed with saline). The disc acts as a catalyst to neutralize the peroxide into water and oxygen. Peroxide is an effective disinfecting agent and it is passively neutralized into pure non-preserved saline solution overnight (minimum 6 hours) by the disc. In the morning the clean and disinfected contact lenses can be removed from the case and put directly in the eyes or rinsed with the non-preserved saline solution before placing in eyes. 4)Once per week a tablet of Allergan (now AMO) Ultrazyme is placed in the AOsept® case along with the AOsept® solution to remove protein. This system works, or shall we say worked, 100% of the time without causing allergy problems.
BUT... Miraflow® Cleaner was discontinued by Ciba (Walgreen's Extra-Strength Daily Cleaner seems to have same ingredients, if one can find it). The excellent Softwear® Saline was also discontinued. For AOsept users Ciba(now Alcon) has been promoting Ciba Clear Care® (also known as AOSEPT® Plus), which eliminates the dedicated cleaner, and which has a "No Rub" designation. It is AOSEPT® without dedicated cleaner and saline solution. There are good reasons for all the components of the original AOSEPT® system. Although hydrogen peroxide is primarily a disinfecting agent, it has cleaning properties as well. It does not, however, clean as well as the original dedicated cleaners. Packaging Clear Care® without a rinsing saline solution, there is the danger of mistakenly getting the peroxide in the eye before it is neutralized in the lens case (Getting Clear Care® solution in the eyes may burn for hours, but it does no permanent damage). Besides warning my patient's about the need for neutralization of Clear Care®, I try to always dispense it with an additional solution for rinsing, either a non-preserved saline solution or MPS. Since I posted the original version of this article in 2006, I have had comments from contact lens patients from across the country, who agreed with my frustration with the contact lens solution manufacturers. As I have suspected, those who were using dedicated cleaners (such as Miraflow®) have said Clear Care® does not clean as well as their previous cleaners. Based on theAndrosko Staining Grid Clear Care may be the best multipurpose solution when used as directed, and Alcon's solutions (OPTI-FREE® PureMoist, OPTI-FREE® Replenish and OPTI-FREE® Express) may come in a close second. Allergy and toxicity do not seem to be a problem with these products. But for cleaning of contact lenses, a dedicated cleaning solution still does the best job, even though the contact lens solution manufacturers seem to deny or ignore this fact.
A system that is very similar to AOSEPT®, using hydrogen peroxide as a disinfecting agent, and utilizing a dedicated cleaner, is AMO's Oxysept® (originally Allergan UltraCare®) System. AMO changed the name to Oxysept® in 2008.
The original Oxysept®/UltraCare® disinfecting system consisted of:
I am in the unique position of being both a patient/member of SCAN Health Plan and a provider/panel member of all VSP vision plans and most EyeMed plans.
As an optometrist I have been dealing with both VSP and EyeMed for decades. VSP (originally California Vision Service or CVS [not the drugstore]) is a non-profit vision insurance provider started in Oakland, California in 1955 by a group of independent optometrists which has always had a mission to offer affordable, accessible, high-quality eye care insurance to the world that promoted visual wellness and improved members' quality of life. Its headquarters was moved to Sacramento, California in 1968, and its dedication to customer service for its members and its network of eye doctors has remained tops in the industry. VSP has the largest network of independent optometrists and ophthalmologists in America, with many different plans for business, government, and individuals. When patients phone an optometrist's office, such as mine, and ask us if we accept VSP, we gladly say "Yes."
On the other hand EyeMed, which is the insurance subsidiary of Italian corporate giant Luxottica Group S.P.A (the world's largest eyewear company, controlling over 80% of the world's major eyewear brands including Rayban, Prada, Oakley, Oliver Peoples, Brooks Brothers, Coach, Ralph Lauren, Versace, et al) is a for profit corporation whose main mission is to make money for its stock holders. Luxottica owns retail outlets Lenscrafters, Pearle Vision, Sears Optical, Target Optical and others.
Although EyeMed has allowed a few token independent optometrists to be part of its provider network its main mission is to steer patient/customers into its own retail outlets to buy the Luxottica eyewear brands. The process that the independent optometrists have to go through to get authorization from Eyemed is much more tedious than VSP. EyeMed will not take telephone calls from the few independent optometrists in its network panel concerning patient eligibility for services, but instead the doctor's office is directed to the EyeMed provider website, which is not user friendly. If glasses are made they must be sent to one of the EyeMed approved laboratories, which we find inferior to the VSP labs.
Having dealt with EyeMed for such a long time, we see many of their methods as deceptive. Many EyeMed vision plans are really not vision insurance plans at all--they pay no money for services and are just "discount" plans. Despite this Eyemed often lists local optometrists like myself on plans we do not accept. When patients phone us to ask if we accept EyeMed we would like to give them a definite answer. Unlike VSP, where we always answer "Yes," (because we accept all the dozens of VSP plans), our answer to an inquiry about EyeMed might bring an answer of "Maybe" or "No." EyeMed has several different provider "networks." We don't know if we are on a patient's EyeMed network until we get information from the member, (their ID or SSN and name and birthdate), and try to decipher EyeMed's website, which will tell us if we are on the patient's network. Starting in 2015, if the patient has SCAN Health Plan we know the answer is "No," because they have limited the number of independent optometrists on the EyeMed SCAN network, even though we have all the credentials to be a participating provider, accept one. That one credential we are lacking is that we do not have our office in a Lenscrafters or Target store. The only optometrists that are on all the EyeMed networks are the ones in the Luxottica owned retail stores like Target and Lenscrafters.
SCAN Health Plan is a non-profit Medicare Advantage Plan HMO that was started in 1977 by a group of senior activists in Long Beach, California to provide better health services for senior citizens. It services only parts of California and Arizona. It traditionally has been one of the most highly rated Medicare Advantage plans in California, one where customer service is paramount. SCAN Health Plan's mission and values seem to be more closely aligned to VSP than EyeMed. So that brings us to the question: Why has SCAN Health Plan gone against its primary mission and core values and dropped VSP to provide vision service in favor of EyeMed?
When patients we have seen for years are told that we no longer take their insurance because SCAN Healthcare has changed from VSP to EyeMed they are understandably upset by this change. If they had known that SCAN was going to make this change they would have changed insurance instead, but now the enrollment period to change insurance has passed.
If you are a SCAN Healthcare member and want to lodge a complaint about this decision by the SCAN Healthcare Plan board of directors you can either fill out the the grievance form on the SCAN Healthcare Plan webside:
or e-mail SCAN Healthcare CEO Chris Wing: Cwing@scanhealthplan.com