Medicated Eye Drops - extremely expensive

[s715855w]

Medicated eye drops -- Xiidra and Miebo -- cost thousands of dollars ($18,000) per year out of pocket since most PDP plans will no longer cover them.  1 plan that will cover them costs $5,500 per year.  The AARP prescription discount card Optum RX doesn't help; it's still over $12,000.  

If you are less than 65 years old, you can get these for $0 - $25 per month but if you are on Medicare, you have to pay thousands!  This is not fair to senior citizens.

How can we get these expensive eye drops added to the list of negotiated drug prices to get them down to what the people less than 65 years of age pay?

[GailL1 · Accepted solution]

They are covered by some Medicare Part D plans - search in your area for plans that cover whichever one that you need.  Medicare Part D plans have a total out of pocket cost of $ 2100 (2026) for drugs covered in your plans formulary.  Find the best one - and that also means financially too -since each beneficiary has to choose the plan that best serves their needs and in this instance you may have to look for an enhanced plan but you are still covered by the OOP limit - $ 2100 - not including the premiums.

Both medication drug sites say they are covered by 70 - 75 % of Medicare Part D plans.  

Yes, there maybe prior authorization, quantity limits for each of them within the plans so that the distribution is verified for the use intended,

Edited to add:  have your asked your doc about switching to another lower cost dry eye med like the generic form of Restasis, known as cyclosporine ophthalmic emulsion?

[SereneSeagull]

I’ve tried several different discount cards over the years.  A new one I found is HIPPO.

Saved a bunch.  Good RX as well.  Shouldn’t have to be like this, you’re right. 👍

[s715855w · Accepted solution]

 I had not heard of HIPPO.  I will check it out.  Thank you for the information!

[SereneSeagull]

You’re welcome.  May not be much for that one, but worth a shot.

[GailL1 · Accepted solution]

They are covered by some Medicare Part D plans - search in your area for plans that cover whichever one that you need.  Medicare Part D plans have a total out of pocket cost of $ 2100 (2026) for drugs covered in your plans formulary.  Find the best one - and that also means financially too -since each beneficiary has to choose the plan that best serves their needs and in this instance you may have to look for an enhanced plan but you are still covered by the OOP limit - $ 2100 - not including the premiums.

Both medication drug sites say they are covered by 70 - 75 % of Medicare Part D plans.  

Yes, there maybe prior authorization, quantity limits for each of them within the plans so that the distribution is verified for the use intended,

Edited to add:  have your asked your doc about switching to another lower cost dry eye med like the generic form of Restasis, known as cyclosporine ophthalmic emulsion?

[s715855w]

 Thank you for the information.  In 2026 only 1 PDP in my area will cover these 2 types of eye drops.  The $2100 (max out of pocket) plus the premiums takes it to over $5,000.  I will check into the cyclosporine.  I appreciate your response!

[GailL1]

@s715855w 

Yes, enhanced plans that have higher priced meds in the upper tiers do come with a higher premium - but some don’t have a deductible - for what that matter with the OOP.  But if the generic Restasis is OK with your doc then it will save you a bundle.  

All (3) are different in make up and how they work to treat the dry eyes - so it will depend on what your doc is trying to target in your condition.  

[CBtoo]

One thing you might be able to do when medicare is excluded from programs is ask if they have a financial hardship program. Usually you have to first prove it isn't on your D formulary and that the D isn't willing to make an exception. Then you can apply to the company for the same kind of help others get. You may have more hoops to jump through than that. I know at least one pharma company does that as I am in the middle of that process.