Does Medicare Cover Restasis?

Dry eye syndrome is caused by a lack of lubrication and moisture on the surface of the eye. Not only can it lead to discomfort, but it may also damage the cornea and cause abnormal vision.

Restasis, which is also known by its generic name Cyclosporine, is an eye drop medication that aims to increase the production of tears in order to lubricate the cornea.

So a common question many people have is, “does Medicare cover Restasis?” In this article, we answer that question in clear, plain English. You will also find the average costs of Restasis and other helpful info.

The short answer is no. In most cases, Medicare will not cover the cost of Restasis. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Restasis.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for Restasis. That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or by Medicare Part D.

Part C and Part D Coverage for Restasis

Some Medicare Advantage plans (Medicare Part C) do provide coverage for Restasis. Medicare Advantage plans cover everything Original Medicare covers and often offer some additional benefits as well. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part D plans also provide coverage for Restasis. 95 percent of both Medicare Part C and Part D plans provide coverage for the medication Restasis.

Most Medicare plans restrict the amount of Restasis you can purchase at one time. If you need to purchase a greater amount of Restasis at one time, Medicare may not cover it. You can either wait until the period has passed before refilling or contact your plan provider and ask for an exception.

Restasis is listed as a Tier 3 drug in the Medicare drug formulary. Most of the time Tier 3 medications are preferred branded medications. Tier 3 medications are more expensive than Tier 1 and 2 medications.

How Much Does Restasis Cost?

A pack of 0.4 ml Restasis which contains 60 vials usually costs around $725. This price will vary from pharmacy to pharmacy.

What Are The Side Effects Of Restasis?

Most medications have side effects, and Restasis is no exception. However, not all side effects are severe and some only occur when we just started taking the medication. This can happen when our body is just trying to adjust to the medication.

Here are some of the side effects of Restasis:

Discomfort in the eye
Redness on the white part of the eye
Pain upon administration
Blurred vision (not common)
Eye irritation (not common)
Headache (not common)
Having difficulty in reading (not common)

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.