Restasis® Medicare Coverage

Restasis®
Chemical name: Cyclosporine

Typical dosage: 0.4ml

Typical type: Eye drops1

Restasis® is a medication typically used to increase tear production for patients who suffer from dry eyes due to inflammation. Restasis is brand name only and is available as an eye drop.

Restasis is a prescription medication that contains the active ingredient Cyclosporine. Patients taking Restasis typically use one drop in each eye twice daily, approximately 12 hours apart.

Restasis is used to increase tear production in patients who have a certain eye condition called keratoconjunctivitis sicca.

The most common side effects of Restasis include burning, eye pain and eye redness.

Does Medicare cover Restasis?

Yes! 94% of Medicare Advantage plans and Medicare Part D plans cover Restasis.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Restasis.

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Average costs for Restasis with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$42 – $652 $19 – $652

Additional information

Wash your hands after use. Do not touch the tip of the applicator to the eye. Use each vial only one time, even if you have medicine left in the vial.

Be sure to take out any contact lenses before using Restasis. Call your doctor if you notice any changes in eyesight or experience very bad eye irritation.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.