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RICHARD G. FISCELLA, B.S.PHARM., M.P.H., is Clinical Professor, Department of Pharmacy Practice, and Adjunctive Assistant Professor, Department of Ophthalmology, University of Illinois at Chicago, Chicago. CHARLES C. LEWIS, B.S.PHARM, M.B.A., is Managing Partner, Jasos Group LLC, Lake Mary, FL. MICHAEL K. JENSEN, B.S.PHARM., M.S., is Clinical Associate Professor, Department of Pharmacy Practice, Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City.

Address correspondence to Mr. Fiscella at the Department of Pharmacy Practice, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612 (fisc{at}uic.edu).

Purpose. The utilization and refill rates of topical ophthalmic fourth-generation fluoroquinolones among physicians, as well as the associated costs, were studied. Methods. A large data set of retrospective pharmacy prescription claims was obtained from multiple plans, including commercial managed care organizations, Medicaid, and Medicare. The data included the number and cost of all new and refill prescriptions for six months for gatifloxacin 0.3% and moxifloxacin 0.5% by physician specialty. New prescription and refill data were also analyzed from a state Medicaid plan to determine if similar trends existed. Results. Primary care physicians wrote approximately 7,000 (7.7%) gatifloxacin and 84,000 (92.3%) moxifloxacin prescriptions, with pediatricians accounting for 4,000 (5.1%) gatifloxacin and 75,000 (94.9%) moxifloxacin prescriptions. Eye care physicians accounted for a similar amount of prescriptions for each antibiotic during the same period. The total cost of prescriptions for all primary care practitioners was approximately $170,000 for gatifloxacin and $2.5 million for moxifloxacin; prescriptions written by pediatricians accounted for $110,000 for gatifloxacin and $2.2 million for moxifloxacin. Conclusion. Prescription drug claims from payers using pharmacy benefit management companies during a six-month period indicated that the numbers of prescriptions written for gatifloxacin and moxifloxacin were similar among eye care physicians, but primary care physicians wrote a greater number of prescriptions for moxifloxacin. Analysis of claims to a Medicaid database revealed an increase in the prescriptions written by primary care physicians for moxifloxacin after its addition to the drug formulary. Index terms: Costs; Drug use; Gatifloxacin; Moxifloxacin; Ophthalmic preparations; Prescribing; Quinolones; Rational therapy