Lowering Eye Medication Costs and Increasing Adherence with Nanodropper with Jennifer Steger and Mackenzie Andrews of Nanodropper: Audio automatically transcribed by Sonix

Lowering Eye Medication Costs and Increasing Adherence with Nanodropper with Jennifer Steger and Mackenzie Andrews of Nanodropper: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
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Saul Marquez:
Hey everyone, welcome back to the Outcomes Rockets. Saul Marquez here. Today I have some extraordinary guests. I have McKenzie Andrews, who is the Chief Commercialization Officer of Nanodropper. She is a Device Design Engineer who earned her master’s degree in Bioengineering with a focus on technology commercialization from the University of Washington. She’s passionate about designing and commercializing solutions to address current health care problems, especially to help close health equity gaps. Also joining us on the podcast today is Dr. Jennifer Steger, who is the Chief Scientific Officer of Nanodropper. She recently completed her Ph.D. in Pharmacology at the University of Washington, and she has nine years of scientific research experience at top academic institutions, including her alma mater, Brown University, Harvard Medical School, and UW. She’s the author of seven peer-reviewed research publications on various topics spanning pharmacology, neurobiology, and endocrinology. And I’m just excited to have them both on the podcast today. They’re doing some extraordinary work around really improving outcomes, reducing costs, and all-around eye health. And so, so exciting to have you both here. Welcome.

McKenzie Andrews:
Hey, thank you.

Jennifer Steger:
Thank you. Glad to be here.

Saul Marquez:
Absolutely. Before we dive into the awesome work that you guys are doing in health care for the eye. I want to learn more about both of you. So tell us and help the audience get to know you both a little bit better. What is it that inspires your work in health care?

Jennifer Steger:
Yeah. So thinking back to really what is at the root of my desire to improve our current health care system, I can really trace it back to watching my family navigate the health care system. As a little kid, my younger sister was diagnosed with a kidney condition that ultimately required that she receive a kidney transplant and leading up to the transplant. She spent years in and out of the hospital and racked up a bunch of medical bills. And I just remember being around seven years old, seeing my mom spending hours on the phone arguing with our insurance company over various claims. And I didn’t really understand what was going on at the time. I just saw how stressed out she was. And from that, I don’t know. That kind of continued as a trend through the rest of my upbringing, just always seeing the stress that was associated with navigating the health care system and also understanding that my sister was extremely lucky to have an advocate in my mom and understanding that most people are not that lucky. I think that just kind of coupled with my interest in science and biomedical research, that ultimately led me to where I am today.

McKenzie Andrews:
Yeah. And then for me, I mean, I’ve been interested just like Jenny in science and math and like all of those geeky things since I was really little. Going into high school, we had a family situation that moved us into a really low socioeconomic bracket. So I guess my background coming from a really low-income family through those really important transitional years going into high school, I just saw a lot of the inequities that most families had to face. I mean, I personally was really lucky because I had a fantastic support system around me. But I know that a lot of folks, just like Jenny was saying, don’t have that type of support system and don’t have those advocates. And so even outside of just navigating the health care system as a low-income individual, I started to develop kind of this passion for solving inequities or just addressing inequities in our whole social system that health care is a really big, big piece of that. It kind of made sense for me to take that kind of geeky, nerdy interest of science, math, engineering, and apply that to a place where I felt like I really could make a difference to help solve inequities. And so that’s what kind of turned me towards the health care system to address some of the inequities in the gaps that we see for some of these marginalized individuals in our health care system.

Saul Marquez:
Yeah, no, I think, you know, I really appreciate both of you sharing your story. And, gosh, I mean, there’s so many stories, you know, and the system is more complicated than it should be. Access is not as good as it should be. There’s a ton of need for improvements. And so, yeah, you know, and at the same time, there’s a lot of good and both of you are doing a lot of good. And so I want to focus on the good being done by both of you and your teams. So talk to us about Nanodropper and what specifically you all are doing here to help close those equity gaps and helping improve outcomes.

McKenzie Andrews:
Yeah, absolutely. So we started Nanodropper. Actually, I was working with Jenny in a neuroscience research lab. We were actually researching drug use disorders. So like addiction and surrounding disorders like stress and anxiety and depression. When our lab manager came to us telling us that she had read this ProPublica article that had been published in NPR about eye drops are too big and how that’s adding to medical waste and at first when she approached me, at least I was like, why in the world are you telling me about this? Like, I don’t care about eye drops. But then she really did frame it as this like health equity issue, that there’s increased waste, which is making these medications really expensive and causing financial barriers to care for patients, ultimately reducing adherence and outcomes. So that’s why we started kind of envisioning a solution to reduce the waste that we see with eye drops. And so what we came up with Nanodropper, just a really simple adapter that screws onto pretty much any eyedrop bottle and it just reduces the drop size is something that the eye can actually absorb. So it makes drops about a quarter the size that they currently are and just really minimizes the waste and financial barriers to care.

McKenzie Andrews:
And we kind of see the solution as helping in a lot of different areas of the health care system. So, of course, for patients, it’s reducing this compounding problem that we see in the health care system of increased waste. There’s a lot of disposable items. And so trying to minimize that waste and then, of course, reduces the costs for the patient and increases access to these vision-saving medications. But then we’re also working directly with eye care clinics. And so we’re able to help these physicians not only improve outcomes for their patients but then they can actually use the Nanodropper in-clinic and reduce the waste in-clinic, reduce their eye drop use in clinics so they’re able to extend those bottle lives and also ultimately makes them less vulnerable to price spikes and drug shortages that we see in the eye care industry, kind of health care industry as a whole. So I kind of really see our innovation as addressing two major problems, this issue of medical waste and then also this shift towards value-based care and really trying to reduce costs while improving health outcomes. And so we’re really trying to be pioneers to fit into the shift towards a value-based care model.

Saul Marquez:
Yeah, I think it’s super interesting. And so maybe this is a good opportunity to level set to, you know, the eye-dropping industry. So there’s probably a lot that we don’t know about medication-wise that gets dropped into the eye other than Visine, for example. You know, this is, I think, where the value gets translated. And so it’d be interesting to hear a little bit more and learn about the medication delivered through the eye. Can you guys teach us something?

Jennifer Steger:
Yeah. Yeah, absolutely. So the interesting thing about the human eye is that it has a discrete capacity so it can only absorb a certain volume of liquid. And anything that exceeds that capacity either spills out of your eye onto your cheeks and rolls down your face, or it’s absorbed through your tear ducts into your body where it can circulate systemically. And with medications like those used to treat glaucoma, systemic absorption of the medication can actually result in some pretty deleterious side effects, including negative effects on your heart and basically lung function. So like beta-blockers, for instance, well, reduce your heart rate and blood pressure and they can be really problematic for people that have like undiagnosed heart conditions or lung conditions. So the other thing is that the larger the volume of the drug that you’re administering or the drop that you’re administering, the faster it’s drained through your tear ducts. So with a smaller drug, basically what we’re doing is we’re just supplying the volume of medication that your eye can absorb and preventing excess absorption systemically and excess waste and overflow.

Saul Marquez:
Yeah, super interesting. And so I guess what kinds of medication? Like what are the different things? So you mentioned glaucoma, right? Are there other things that maybe we don’t know about that would be interesting to learn about?

Jennifer Steger:
Yeah. Yeah. So chronic dry eye disease is a condition that affects tens of millions of Americans, although with that being said, there are some incompatibilities between Nanodropper and many of the bottles that the prescription medications for dry eye disease are packaged in. But other conditions like cataracts receiving, like after you have your cataracts removed, you oftentimes take prescription eye drops to deal with inflammation and potential infections that could result from that. So, yeah, when I first started learning about a Nanodropper and thinking about all of that, I was shocked at just how many individuals require eye drops.

Saul Marquez:
Yeah, it’s a big market. And, you know, not a lot of people know about that. And so that’s what happened in the industry. Right. you have these small niches where they oftentimes go unquestioned because you’re like eye drops. OK, big deal. But if you really dive deep, as you guys have. You start to find that there’s waste, that there are opportunities to get better, so talk to us a little bit about what makes you guys different and how you’re improving outcomes. We’d love to hear more about that.

Jennifer Steger:
Yeah. So Nanodropper is actually the only true eye drop bottle adapter on the market. There are other solutions that have tried to address this problem by reducing drop volume, but they’ve really focused on repackaging the medication. So providing a completely new packaging system for the end-user. But by basically adapting to the current bottle, we are allowing patients to continue using their eye drops as they normally would. It also cuts down on costs because a lot of these repackaging solutions actually increase the per-unit cost. So driving up the cost to the end-user. And then, like I was kind of talking about or alluding to earlier, by reducing the volume of the drops compared to the current commercially available oversize drops, we’re basically reducing side effects, increasing the use of an individual bottle. And in doing so, we believe that will be increasing adherence and therefore further increasing health outcomes.

Saul Marquez:
Yeah, for sure. There’s such an interesting space and application. So you design the adapter and it goes on these bottles and you just put it on. How do you know that you’re getting the right amount of medication?

McKenzie Andrews:
Yeah, we really like to frame this what Jenny was saying earlier, how the eye has a limited capacity. Kind of the analogy we sometimes make is, I think, big about filling up like a glass of water. We personally like to say a wine glass. And some of you like you can like have your wine glass and you can take the bottle and pour yourself a glass of wine and just fill it to the top and drink your wine. You could also take the bottle and pour the whole bottle into your wine glass and you’d be left with the same amount of wine in your glass, but then the rest of the bottle would be all over the table on the floor. And that’s basically what’s happening to the eye. When you’re putting in these oversized drops, you’re feeling the eye, putting as much medication as the eye can hold. And then the rest overflows and it’s either going onto your cheek or as Jenny said, it’s being drained and absorbed systemically, which is not only wasteful but also deleterious to the patient. It’s increasing those side effects. So there are decades of clinical research showing that what the absorption capacity is, it’s about seven to 10 microliters.

McKenzie Andrews:
And for a sense of scale, current eye drops are anywhere between thirty-five and we even see them up to 70 microliters. So like a lot of excesses there. And yeah, I really think it’s something that people just don’t think about. You get a drop out of a bottle and people just kind of assume that that’s what a drop of liquid is. We actually have a lot of people asking us, like I just thought that drop of solution is just always a consistent size and that’s just really not the case. It depends on the material that’s coming out of, adherence properties, the size of the whole, like all of that stuff do contribute to the size of the drop. And so we have figured out a way to control the necessary variables so that we get just the perfect amount of drop out every time. So we administer drops that are between 10 and 15 microliters, depending on the viscosity of the fluid in different actual fluid properties. But we’re really just ensuring that patients are always getting enough medication. That’s right at the upper end of the absorption capacity, but really minimizing any excess that’s going into their eye.

Saul Marquez:
Fascinating. So one of the things that I think you guys were made some announcements about was how you work with the Air Force and they contributed a nice amount of money toward this project, half a million dollars. Tell us about that and why such interest from the Air Force to support your effort?

McKenzie Andrews:
Yeah, definitely. I mean, the Air Force is phenomenal. So for people that aren’t really aware, there are these contracts or grant opportunities called SBIR. So small business innovation and research awards. And they’re offered by a lot of different agencies, the National Institute of Health, the National Science Foundation. So there’s a lot of different opportunities to get these like small business awards, SBIR awards, and actually the military, different departments of the military offer SBIR’s. And so that’s actually why our Air Force contract is. It’s through the SBIR program in the Air Force called Afworks. Afworks is just amazing. They’ve really innovated on the traditional kind of DOD Department of Defence SBIR program where instead of having a specific needs statement so that the Navy might be like, we want better technology for tracking underwater missiles, something like that, instead of just putting out that needs statement and only accepting applications for companies that might have a technology that fits that need, the Air Force is just said, we’re open to hearing anything that you think could benefit the Department of Defense, the Air Force, our active-duty military, so that’s what we applied to under this kind of open topic because we know that the same eye conditions and issues that are present in the private sector, of course, are present with our active-duty population as well, and especially for the Air Force, eyesight is so critical for these airmen that are flying airplanes and really high stakes situations. And so we just saw this as an opportunity to address this issue of adherence and side effects and all of the health concerns surrounding these oversized drops for our active duty personnel so they can maintain their vision and their ability to continue with the goals of the Air Force. So that’s kind of the agreement that we worked out with the Air Force. We’ll help their active-duty airmen and they’re going to support our efforts in doing so.

Saul Marquez:
That’s awesome. Congratulations to you guys on that. That’s an incredible partnership. And just to think about the ripple effect of some of the benefits that your work is is going to have on these people in our country. So I think that’s fantastic. So as the team works together to make the adaptor better and just to reach the right people, what would you say is one of the biggest setbacks you’ve experienced and a key learning that came out of that?

Jennifer Steger:
Yeah, definitely. So we actually launched our product this past June, so not dive in the middle of the pandemic. And one of the setbacks we experienced during that process was listed as a sterile medical device with the FDA. And we are actually strategically manufactured entirely in the United States for a number of reasons. There are a number of considerations. But of course, with the pandemic, US medical device sterilization facilities were prioritized for essential medical equipment. And so, of course, we happily went to the back of the line to prioritize that equipment. But that was definitely a step back. You know, it pushed back our launch date. We had a bunch of presale orders, customers that had already reserved their initial nanodroppers that had to wait. But I mean, ultimately, it was a relatively short setback. It was a month or two that pushed back our launch. But we are still able to get the nanodropper out there during a time when I think patients and clinics kind of needed it the most. There’s not only all this concern around health, but also there are a lot of economic impacts with the pandemic. And so a lot of not only patients but also these small clinics, you know, their small businesses too become really financially conscious and trying to save costs where they could. So we felt really fortunate that we were still able to fit in to the medical device production space even admits that big impact of the pandemic and still be able to get our product out there.

Saul Marquez:
Fantastic. Yeah, it’s it was a challenge for everyone. And it sounds like you guys had your fair share of the challenge and ultimately you were able to get the product manufactured and shipped. So congratulations. And so as you look into the horizon, what are you most excited about today?

Jennifer Steger:
Yeah, well, we’re excited about quite a bit. This is just a big year for our company overall being shortly after we launched. But I think I’m most excited about the clinical trials. We’ll be running one at Arvind Eye Care System, which is the largest hospital in the world, really, by patient volume. And we’re also running a number of trials with partners and collaborators in the US. But it will be really nice just to collect some clinical data that evaluates the safety and efficacy of nanodropper relative to the standard of care. And I think this will really hopefully drive adoption and trust.

Saul Marquez:
Yeah, that is exciting. And especially as you look to expand the product and its utility to larger systems, payers,

Jennifer Steger:
Exactly.

Saul Marquez:
They’re all about the data, right?

Jennifer Steger:
Absolutely.

McKenzie Andrews:
I mean, I think that that really gets to what I personally am super excited about. I mean, of course, the clinical trials are huge, but I’ve just been so thrilled to watch that’s already kind of expanding into this huge industry that is eye care. I mean, we have partner clinics in over a dozen states now and Washington, D.C. So that has been amazing. We’re really expanding those local access points for patients. And then on top of that, we have also been able to launch the kind of the first step of one of our programs to help improve access for really low-income individuals. It’s called the Give the Gift of Vision program. And part of what we are able to do through that program is set up a donation system. So individuals, they understand how important access to eye care is, can actually donate Nanodroppers directly through our website. And then we have a signup program where patients who are concerned about their ability to afford their medications or even concerned about their ability to afford the nano dropper just because they’re on fixed incomes or whatever the situation might be, are able to sign up to receive one of these prepaid donated Nanodroppers. And we’ve already just heard some incredible stories from the folks that we’ve been able to start helping through that program. And so I think that that really hits home for me coming from that really low-income background where even $14.99, which is the cost of the nano dropper, would have been a huge expense for my family. And so being able to help those individuals that really need it the most, that’s something that I’m really excited about. And it’s been really gratifying to see that play out.

Saul Marquez:
That is very gratifying. And so where does this go? You know, what’s the future? I love to hear from either of you, Jenny or McKenzie and what you see, what does success look like.

McKenzie Andrews:
Yeah, I mean, I really think that. So right now we are available to the patients, into eye care clinics to purchase our device. But we really see the nano dropper as having implications really every step of our health care system. So we designed this direct to a patient-centered solution. But the best way to reach these patients and increase access points is really to partner with these larger systems, these larger institutions, the health care networks, they are ultimately supplying the care. And so that’s something that we are really working on right now, is those clinical trials are going to be a huge piece of that puzzle, getting all of that data really showing that we have developed a data-driven solution and then partnering with larger institutions to get the name of dropper out there to everybody that needs it, not only in the US, but we’re also looking at international expansion and then kind of on that same track we’re also hoping to help with some global health efforts. Right now, it’s really difficult to address glaucoma and lower resource settings just because of the nature of the disease. It’s a chronic disease. You need to take eye drops every day to keep it managed. And these medications are really expensive. So to address that in these lower resource settings where maybe a physician is able to go in once a year and bring as much medication as they can fit on the plane ride, but then they have to leave and there’s nobody there to make sure that medication is lasting long enough for these patients. We’re really hoping that we might have a place there to kind of make global health for glaucoma care, but also other eye conditions like cataract surgery and stuff a bit more pragmatic and hopefully improve outcomes for not only the developed world and Americans in the United States, but globally.

Saul Marquez:
I love it. I love it. I think it’s such a great vision. Jenny, anything that you wanted to add to that?

Jennifer Steger:
I feel like McKinsey did a great job of covering it. Yeah. I mean, I would just love to see better health outcomes as a result of the adoption of the nano dropper. I think that to me would really signify success because it would mean that we’ve accomplished what we’ve set out to do.

Saul Marquez:
Yeah. You know, a new standard of how to manage this worldwide is certainly moving. I mean, do you think the United States alone. I mean, three hundred some million people, but globally, the impact you could have is really exciting. So I definitely see the vision and we’re rooting for you guys to really have more success because it’s another opportunity to help with access, with improving overall outcomes for people. Take it home, guys. Where do folks go learn more and how can they get in touch?

Jennifer Steger:
People can order the Nanodropper off of our website at Nanodropper.com. They can also purchase in person at one of our partner clinics, which they can find out about also on our website, we have a map feature. If they want to reach out to us, they can send us an email at Info@nanodropper.com. And we’re also on all social media platforms, including Instagram, Facebook and Twitter, so they can find us.

Saul Marquez:
They’re outstanding. Well, thank you. And Mackenzie, any closing thoughts from you?

McKenzie Andrews:
Yeah, I mean, I also just want to point out that we’re really focused right now on expanding our partner clinic network. We see that as a great way to increase access points for patients like Jenny. We were saying these places where patients can actually go in person and purchase the nanodropper. And so any partner clinics or any clinics out there that would like to become a partner and use nanodropper in clinic or offer it to their patients can reach out to us. And it’s a super quick process to get you set up. And we would just love to increase those access point.

Saul Marquez:
Well, there you have it, folks. Just the outstanding work by Mackenzie and Jenny and the Nanodropper team. The website is Nanodropper.com or just go to outcomesrocket.health, type in nanodropper in the search bar. You’ll see the full episode there with show notes and links, different ways to get in touch and to get your own nanodropper. So just want to say thank you. Thank you both for the work you’re doing. And we’ll be rooting for you and the work that you and your team are up to.

McKenzie Andrews:
Thank you so much and thanks for helping us get the word out.

Jennifer Steger:
Yeah, thank you.

Saul Marquez:
Absolutely.

Saul Marquez:
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