New LD-DTO Solutions Likely


During 2020 we saw a measurable uptick in the number of FDA approved therapies that were LD-DTO….. which you should know stands for Limited Distribution, Direct-to-Office (LD-DTO) for office administration. 

Manufacturers have gotten very comfortable with specialty pharmacies dispensing their products and managing patients through traditional Limited Distribution (LD) direct to patient. They are rapidly warming up to the idea of specialty pharmacies also handling their buy-and-bill meds, especially for orphan drugs and those that may be out of the ordinary and in need of some ‘specialty’ tender lovin’ care. 

Here’s an example of a new application of LD-DTO that we tripped across recently. 

Orsini Specialty Pharmacy was selected some months ago by Glaukos Manufacturing to manage a drug originally launched in 2016. The therapy, Photrexa / Photrexa Viscous, is shipped DTO and is used incident to a procedure called corneal collagen cross-linking (CXL) by a corneal specialist. 

So why go to Orsini to set up a specialty pharmacy LD-DTO solution years after original launch? The specialists were still running into reimbursement issues, challenges with inventorying high cost therapy, and complicated billing practices as the drug incident to an eye laser procedure. 

The drug has an AWP of $3750 per eye….. so it is in the specialty pharmacy sweet spot. Orsini has worked with payers and PBMs to open up the AOB billing option and those efforts are paying off. Specialists and patients are equally enjoying the journey on increasingly smoother roads. 

As other manufacturers see the benefits of such a relationship we will likely see more LD-DTO deals in the future.    


Orsini Specialty Pharmacy Selected By Glaukos® Corporation As A Specialty Pharmacy Distribution Partner For Photrexa® And Photrexa® Viscous 

ELK GROVE VILLAGE, Ill., Jan. 19, 2021 /PRNewswire/ — Orsini Specialty Pharmacy, a leader in rare diseases and gene therapies, announced today that it has been selected by Glaukos® Corporation as a specialty pharmacy distribution partner for Photrexa® (riboflavin 5′-phosphate ophthalmic solution) and Photrexa® Viscous (riboflavin 5′-phosphate in 20% dextran ophthalmic solution) for the treatment of patients with progressive keratoconus and corneal ectasia following refractive surgery. Using Photrexa Viscous and Photrexa with a proprietary UV light delivery system, Glaukos’ iLink™ corneal cross-linking procedure is the first and only FDA approved therapeutic treatment that strengthens the cornea to slow or halt the progression of keratoconus. 

Keratoconus is a rare, degenerative eye condition that occurs when the normally dome-shaped cornea weakens and begins to bulge into a cone-like shape resulting in vision loss. Keratoconus often appears in individuals who are in their late teens to early 20s and occurs in approximately 1 out of every 2,000 people in the United States.   

“We are honored to be Glaukos’ specialty pharmacy partner for Photrexa, which offers hope for individuals with progressive keratoconus,” said Mike Fieri, Orsini Chief Executive Officer. “Our dedicated Photrexa Care Team is committed to providing high touch, individualized services for people with this condition.” 

Tim Homer, Vice-President of Global Market Access added, “We at Glaukos are excited to partner with Orsini. This partnership offers our providers the option of obtaining Photrexa through a specialty pharmacy so they can focus on providing access to the iLink procedure to their patients.” 

About Orsini Specialty PharmacyProviding patients with comprehensive and compassionate care since 1987, Orsini is a leading, independent specialty pharmacy focused on rare and ultra-rare diseases and gene therapies. Orsini’s high touch care model is centered around experienced, therapy-specific care teams who provide personalized care to patients based on their specific condition and treatment. The company’s comprehensive solutions include medication adherence programs, data analytics, customized manufacturer programs and nationwide nursing coverage for convenient in-home infusion services. Headquartered in Elk Grove Village, IL, Orsini Specialty Pharmacy holds accreditations with the Accreditation Commission for Health Care (ACHC), The Joint Commission, URAC, NABP, and most recently was awarded ACHC’s Distinction in Rare Diseases and Orphan Drugs. 

About Glaukos CorporationGlaukos ( is an ophthalmic medical technology and pharmaceutical company focused on novel therapies for the treatment of glaucoma, corneal disorders and retinal diseases. The company pioneered Micro-Invasive Glaucoma Surgery, or MIGS, to revolutionize the traditional glaucoma treatment and management paradigm. Glaukos launched the iStent®, its first MIGS device, in the United States in July 2012, its next-generation iStent inject® device in the United States in September 2018 and most recently, its iStent injectW device in the United States in October 2020. In corneal health, Glaukos’ proprietary suite of single-use, bio-activated pharmaceuticals are designed to strengthen, stabilize and reshape the cornea through a process called corneal collagen cross-linking to treat corneal ectatic disorders and correct refractive conditions. Glaukos is leveraging its platform technology to build a comprehensive and proprietary portfolio of micro-scale surgical and pharmaceutical therapies in glaucoma, corneal health and retinal disease. 

For more information about Orsini’s specialty pharmacy services, contact us at 847-734-7373 ext. 545, e-mail us at, or visit

iLink™ is a trademark of Glaukos Corporation. Glaukos and Photrexa® are registered trademarks of Glaukos Corporation.


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