Restasis Prescription Coverage Through Medicare

In this article...
  • Dry eye is a common condition among older adults, and Medicare Advantage or Medicare Part D plans may help cover some or all of its costs. Find out more.

Chronic dry eye is a medical condition in which the tear ducts don't produce enough tears needed to keep the eyes well-lubricated, often resulting in dryness and irritation of the sensitive eye tissues. Chronic dry eye is generally diagnosed by an ophthalmologist, who may also prescribe artificial tear eye drops such as Restasis to help keep the eyes hydrated.

Does Medicare Cover Restasis?

While specific coverage options may vary based on plan availability and geographical locations, approximately 94% of Medicare Advantage plans and Medicare Part D prescription plans provide coverage for Restasis. Actual out-of-pocket costs may also vary depending on whether a Medicare recipient is in the deductible stage or copay stage. 

Medicare beneficiaries in the deductible stage are generally responsible for 100% of their prescription costs until their deductible is met. During this time, recipients should expect to pay between $42 and $774 for each Restasis prescription. After meeting the Medicare deductible, recipients are only required to pay copayments or coinsurance payments, which can help lower costs significantly. The average cost for Restasis during the typical copay stage ranges from $1 to $100.

How Long Should You Use Restasis?

In most cases, individuals who are prescribed Restasis must use the medication for at least 6 months, even if dry eye symptoms show improvement. Specific time frames can vary from person to person, and results are often assessed by an eye doctor after 6 months to determine if prescriptions should be extended. 

Can Restasis Make Dry Eye Worse?

When used as intended, Restasis is meant to moisturize the eyes and reduce uncomfortable symptoms. However, Restasis is formulated for use once every 12 hours, and overuse can further irritate the delicate eye tissues and exacerbate symptoms of dry eye. In some cases, Restasis may cause adverse side effects such as eye discharge, blurry vision, burning and stinging. 

Is Restasis Safe for People Who Wear Contact Lenses?

Restasis is considered safe for people who wear contact lenses. Users should remove their contact lenses prior to applying the drops and wait 15 minutes before putting the lenses back in to ensure the medication is properly absorbed. 

What Are Some Symptoms of Chronic Dry Eye?

Individuals with chronic dry eye may experience symptoms such as eye dryness, itchy and burning eyes, excessive eye tearing and a feeling of grittiness in the eyes. Chronic dry eye may also make it difficult or uncomfortable to wear contact lenses and cause eye inflammation or redness. 

What Causes Chronic Dry Eye?

Temporary or chronic conditions that alter tear duct function are often responsible for chronic dry eye. Inflammatory conditions such as lupus and rheumatoid arthritis cause damage to the tear ducts, resulting in dry eyes. Decreased corneal sensation caused by long-term contact lens wear and viral eye infections are also linked to chronic dry eye. Blepharitis is a common condition with symptoms such as tenderness and plaque along the eyelids that's known to damage the eye's tear film, which can lead to chronic dry eye.

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