Unilateral pricing policy (UPP) of contact lenses has made recent headlines. Why is UPP good for optometry, and why should students bother to understand its importance to the profession? UPP is a policy implemented by many contact lens manufacturers to set a base and minimum price for their contacts. In doing so, companies are changing the perception of contacts from a commodity purchased on sale by shopping around to a valuable medical device that preserves vision and health. As optometry students creating our clinical foundations, we must understand UPP and its impact on patients.
Money can get in the way of health. During my first ever contacts exam in clinic, the patient complained about extreme dryness with her contacts. I unfurled my why-you-should-try-dailies speech that I had worked on the night before, and the patient was enthusiastic about the possible improvement in dryness. Then she asked about the cost, and she insisted on knowing our exact price. She took her phone out, swiped away, then looked up at me and said that she’d like to be re-fit into her current contacts because a website was having a sale on her current lenses. I implored her to reconsider because her extreme dryness would persist and that I had a solution ready, but her mind and wallet were made up because of the sale price.
Understandably, patients are concerned about the cost of their prescribed contacts. Discussing prices and the value of newer contacts is a conversation all optometry students should practice while in clinic. Before UPP, these conversations were convoluted because of confusing rebates and questions about cheaper pricing online. Much of the patient-doctor interaction revolved around pricing instead of new opportunities for improvement in vision and comfort or proper contact lens hygiene. With a unilateral price for contacts, optometrists and patients can focus on contact lens performance and less on cost.
From the patient’s perspective, UPP will elevate the status of contacts from a commodity easily purchased with sales and rebates to a premium health product. Previously, contacts had been advertised as discountable items with great emphasis on discounts as opposed to increased health benefits. Traditionally, UPP has been used with premium products such as Apple’s iPad or Tiffany’s jewelry to force customers to consider value and benefit as opposed to finding a lower price. Optometry students should support this paradigm shift and promote the health benefits of different contacts as opposed to simply differentiating them by cost. UPP allows the doctor to return to focusing on health instead of economics.
In addition to allowing optometrists to provide better care, UPP provides benefits for patients. Since implementing UPP, manufacturers have discontinued their confusing rebate systems. Even with the opportunity to save money, only 6-8% of patients returned rebates.1 Because the discount is now factored into the UPP price instead of contacts, Johnson & Johnson has reported prices for contacts have been reduced by 60% of patients because of UPP.2 With no financial incentive to order contacts online instead of from optometric clinics, patients benefit from lower risk of counterfeit contacts and improved visual health. Contacts purchased over the internet have been found to be associated with microbial keratitis,3 poor patient education regarding contact lens care,4 patient risk of potential harmful eye care practices,5 and other complications.6 When patients order contacts from a clinic, they will benefit from prompt customer service if there are problems with vision or comfort, as well as patient education and care. These are benefits that optometry students should explain to patients because they are usually unaware of the convenience that comes from ordering contacts in-office as opposed to online.
UPP has clear benefits for both optometrists and patients through providing better care. Currently UPP is under attack by contact lens distributors who are fearful of a decrease in business, and the AOA has defended UPP in front of the Senate. UPP is not an issue to be taken lightly. Optometry students are great in evaluating and providing successful contact lens fits, but we should also be knowledgeable about the real world impact of contacts on our patients. UPP is gaining traction in the optometric world, and it is a welcome change for both optometrists and patients.
1Most ODs support new contact lens pricing strategies. Primary Care Optometry News, October 2014.
2Knight, Millicent. Important update on Contact Lens UPP. Vistakon ® Division of Johnson & Johnson Vision Care, Inc.
3Stapleton F, Keay L, Edwards K. Naduvilath T, Dart J, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008;115(10:1655-1662. DOI: http://dx.doi.org/10.1016/j.ophtha.2008.04.002
4Wu Y, Carnt N, Stapleton F. Contact lens user profile, attitudes and level of compliance to lens care. Contact Lens and Anterior Eye. 2010;33(4):183-188. doi:10.1016/j.clae.2010.02.002
5Fogel J, Zidile C. Contact lens purchased over the internet place individuals potentially at risk for harmful eye care practices. Optometry. 2008;79(1):23-25. doi:10.1016/j.optm.2007.07.013
6Young G, Young AG, Lakkis C. Review of complications associated with contact lenses from unregulated sources of supply. Eye Contact Lens. 2014;40(1):58-64. doi: 10.1097/ICL.0b013e3182a70ef7