Does Medicare cover Restasis?

Medicare Part D prescription drug plans usually cover the costs of Restasis (cyclosporine ophthalmic solution) or the generic equivalent, a prescription eye drop approved by the FDA to treat chronic dry eye disease caused by inflammation. You may receive the generic at the pharmacy depending upon your Medicare plan coverage.

An ophthalmologist or optometrist can prescribe Restasis after an eye examination. Be sure to speak with your eye care professional about medication costs before treatment.

How much does Restasis cost with Medicare?

Prescription copays and deductibles will vary among plans. Your costs and coverage will vary depending on individual Medicare Part D drug coverage or your Medicare Advantage plan. Costs can also be affected by a Part D coverage gap (“donut hole”) and which state you live in.

Call or search online to determine if your Medicare Part D or Advantage plan covers Restasis or the generic option. Ask what your copay or deductible is, if you must meet your deductible first and which alternatives are available. You can talk to your doctor about the alternatives to Restasis to determine an appropriate substitute for dry eye disease, if needed.

Some Medicare prescription drug plans may require a prior authorization or step therapy before you can get Restasis or the generic. Your doctor will need to fill out paperwork for the insurance company to show that you require this drug over other treatments. There may also be quantity limits on the amount of medicine you can get at once.

What are the alternatives to Restasis?

Other brands for cyclosporine ophthalmic eye drops for dry eye are available. These products differ slightly in strength and there are no generics available yet.

• Cequa
• Verkazia
• Vevye

Other prescription medicines approved by the FDA for the treatment of dry eye include:

• Tyrvaya (varenicline solution)
• Xiidra (lifitegrast 5%)
• Miebo (perfluorohexyloctane ophthalmic)

Tyrvaya is nasal spray is used to treat dry eye disease, while Xiidra and Miebo come as eye drops

How much does Restasis cost?

For people paying cash out-of-pocket, the cost of Restasis ophthalmic emulsion 0.05% is around $689 for a supply of 60 vials (a one month supply). The generic option for Restasis is called cyclosporine 0.05% ophthalmic and costs $245 for 60 vials.

These prices are based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.

Learn more: Restasis Prices, Coupons and Patient Assistance Programs

Related questions

• Is there a generic for Restasis eye drops?
• Xiidra vs. Restasis: Which is better for dry eye?
• Why is Restasis so expensive?

How do I get Medicare drug coverage?

Medicare is a national medical insurance plan for people 65 years and older in the U.S. You would generally first be eligible to sign up 3 months before your 65th birthday. You may be eligible earlier if you have a disability, severe kidney failure, or ALS (also called Lou Gehrig’s disease).

Part A is generally free for most people, Part B has a monthly premium which can change each year (in 2024 it is $174.70 per month) and the cost for Part D (the separate drug insurance) will depend upon the plan and coverage you select.

Medicare Part D

You can get drug coverage for Medicare in two ways: either by buying as a separate Part D insurance plan to go with Part A and Part B, or by buying as a bundled product called a Medicare Advantage Plan (Medicare Part C).

If you get Medicare Part A and B separately through the government, you will need to add an individual Medicare Part D plan to have coverage for the cost of medicine.

Medicare drug coverage helps to cover brand-name and generic drugs at your pharmacy. Each Medicare Part D plan has a formulary which is a list of medications the plan will cover each year. Companies that sell Part D plans individually include United Healthcare, Aetna and Humana. Drug coverage and copays can and does often change yearly.

Copays and prices for the drugs on Part D plans can vary based on whether they are a preferred product on the formulary. Generics, when available, tend be preferred over brand name drugs due to lower costs.

Drug coverage varies between plans, so when considering a Part D plan look at the plan’s covered prescription drug list to be sure it meets your needs.

Medicare Advantage Plans

Medicare Advantage plans (called Part C) can be purchased through private insurance carriers like United Healthcare, Aetna, Humana or BCBS.

They typically bundle hospital coverage through Medicare Part A, medical insurance through Part B, and prescription drug coverage through Part D. Additional options, like an over-the-counter (OTC) benefit, vision plans, hearing tests and dental coverage may also be available.

Check with each Medicare Advantage Plan individually to determine your drug coverage and costs for dry eye disease.