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With all of the excitement around the eye drop Rhopressa’s recent approval by the Food and Drug Administration of the United States, you may wonder, “Does Medicare Cover Rhopressa?”
In this article, we answer the question in clear, plain English. You will also find the average costs of Rhopressa and other helpful info.
Does Medicare Cover Rhopressa?
The short answer is no. In most cases, Medicare will not cover the cost of Rhopressa. 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 Rhopressa.
Original Medicare Coverage of Rhopressa
Original Medicare (Medicare Part A and Part B) does not provide coverage for Rhopressa.
This is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. So, is there any situation when you might get covered?
Medicare Advantage Coverage of Rhopressa
Indeed, some Medicare Advantage plans (Medicare Part C) provide coverage for Rhopressa. The Advantage plans cover everything Original Medicare covers but they also offer some additional benefits that Parts A and B do not cover.
However, coverage and out-of-pocket costs will vary depending on the plan and provider you have.
Ninety percent of both Medicare Part C and Part D plans provide coverage for the medication Rhopressa.
Medicare Part C plans that include prescription drug plans will also provide coverage for medications your healthcare provider will prescribe to you. Medicare Part D is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.
Are there any Restrictions on Rhopressa?
Some Medicare plans restrict the amount of purchase for Rhopressa to one bottle per purchase. If you need to purchase a greater amount of Rhopressa at one time, Medicare may not cover it.
Your options here are to either wait until the period has passed before refilling or to contact your plan provider and ask for an exception.
The Medicare drug formulary contains five tiers, and Rhopressa is listed as a tier 3 drug. Most of the time, Tier 3 medications are preferred branded medications.
How Much Does Rhopressa Cost?
Tier 3 medications are also more expensive than Tier 1 and 2 medications.
The average cost of 1 eye dropper (2.5ml) of Rhopressa 0.02% is $354.38.
What Is Rhopressa?
Rhopressa (Netarsudil) is a medication that lowers the amount of pressure that is present in the eye and treats open-angle glaucoma. There is no generic equivalent to Rhopressa available at this time.
The use of these drops is supposed to assist in lowering the pressure that is present within the eye by reducing fluid from the eye. It is essential to follow the directions provided by the physician regarding the dosage. Typically it should only be made once each day, preferably in the evening.
There is a possibility of experiencing discomfort, redness, or soreness in the eyes, blurring of vision, and staining of the cornea. Vision changes and increased discomfort are examples of more serious adverse effects. However, many people do not experience these.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare cover Proton Beam Therapy?