Cost and availability of high-dose oral prednisone for management of optic neuritis.

Objective: This study assesses the cost and availability of 1250 mg of oral prednisone for treatment of optic neuritis across pharmacies in Toronto.

Design: Prospective cross-sectional study PARTICIPANTS: Data collected from 70 pharmacies, across 4 regions in Toronto, Ontario, Canada METHODS: Data were collected from 70 pharmacies on cost and availability for 3- and 5-day courses of prednisone. Pharmacist hesitancy was assessed on the basis of the readiness of the pharmacist to dispense the required dose of medication.

Results: The average cost for a 3-day course of prednisone was $29.10 CAD, and for a 5-day course was $40.40 CAD. Availability was lowest in independent pharmacies (23.8%) and highest in chain pharmacies (47.6%). Although no significant association between availability and pharmacy type was found (χ² [1; N = 63] = 3.66; p = 0.06), the direction of the effect still shows an indication of chain pharmacies having higher stock. Chain pharmacies also exhibited the highest cost variability. Finally, 40% of pharmacists had some hesitancy or refused to dispense the appropriate dose.

Conclusions: There is limited availability of high-dose prednisone across Toronto, with chain pharmacies offering the highest availability but at a higher cost. There is significant hesitancy about dispensing this prednisone dose among pharmacists. Clinicians should be aware of these trends when prescribing medication for optic neuritis. Neuro-ophthalmologists should aim to develop relationships with pharmacies to improve timely administration of this medication.