What is Xiidra and How Does It Treat Dry Eye?

Xiidra (lifitegrast) is a prescription medication specifically designed to treat the signs and symptoms of dry eye disease. Unlike artificial tears that provide temporary relief, Xiidra works by reducing inflammation that can cause dry eye symptoms.

The active ingredient in Xiidra, lifitegrast, belongs to a class of medications called lymphocyte function-associated antigen-1 (LFA-1) antagonists. It works by blocking the interaction between two proteins that contribute to inflammation in dry eye disease. By reducing this inflammation, Xiidra helps increase tear production and decrease eye discomfort, burning, and stinging associated with dry eye.

Typically, Xiidra is prescribed as one drop in each eye, twice daily, approximately 12 hours apart. It comes in single-use containers to ensure proper dosing and prevent contamination. Many patients begin to notice improvement in their symptoms within two weeks of starting treatment, though the full effects may take longer for some individuals.

Medicare Coverage Categories for Prescription Medications

Understanding how Medicare covers prescription medications like Xiidra requires knowing the different parts of Medicare and how they work together. Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), generally does not cover most prescription medications you take at home, including eye drops like Xiidra.

Medicare Part D is the prescription drug coverage component that would typically cover medications like Xiidra. Part D plans are offered by private insurance companies approved by Medicare, and each plan has its own formulary (list of covered drugs) and cost structure. Medicare Advantage plans (Part C) often include prescription drug coverage similar to Part D.

Medicare prescription drug plans categorize medications into different tiers, with each tier having a different cost-sharing amount. Specialty medications like Xiidra are often placed in higher tiers, which means they typically have higher copayments or coinsurance amounts. The specific tier placement affects how much you'll pay out-of-pocket for this medication.

Xiidra Cost Comparison Under Different Medicare Plans

The cost of Xiidra varies significantly depending on your specific Medicare plan. Without insurance, Xiidra's retail price can be approximately $500-$600 for a month's supply (60 single-use containers). With Medicare Part D or Medicare Advantage coverage, your actual cost will depend on several factors.

Medicare Part D plans typically place Xiidra in Tier 4 or 5 (specialty tiers), which means beneficiaries may pay 25-33% of the medication's cost after meeting their deductible. For example, if Xiidra costs $550 and your plan requires 30% coinsurance, you might pay around $165 per month after meeting your deductible.

Some Medicare Advantage plans might offer more favorable coverage for Xiidra, with fixed copayments instead of percentage-based coinsurance. For instance, you might pay a flat $100 copay regardless of the medication's full price. To compare specific costs, you can use the Medicare Plan Finder tool to see how different plans in your area cover Xiidra.

It's worth noting that if you reach the Medicare Part D coverage gap (donut hole), you'll pay 25% of the plan's cost for brand-name drugs like Xiidra. If you reach the catastrophic coverage phase (after spending $7,050 in 2023), you'll pay 5% of the cost or a small copay for the remainder of the year.

Patient Assistance Programs for Xiidra

If the cost of Xiidra with Medicare coverage remains prohibitive, there are additional options to help reduce your out-of-pocket expenses. Novartis, the manufacturer of Xiidra, offers patient assistance programs that may help Medicare beneficiaries afford their medication.

The Xiidra iinsider patient support program provides savings offers that can reduce out-of-pocket costs for eligible patients. While Medicare beneficiaries are generally not eligible for manufacturer coupons due to federal regulations, they may qualify for Novartis's patient assistance foundation, which provides medications at no cost to qualifying individuals.

Additionally, independent charitable foundations sometimes offer assistance for Medicare patients. Organizations like the Patient Advocate Foundation or NeedyMeds can help you identify programs you might qualify for. These programs typically have income requirements and application processes.

Some Medicare beneficiaries might also explore therapeutic alternatives to Xiidra that may be covered at a lower cost tier. Discussing these options with your healthcare provider could lead to finding a more affordable treatment for your dry eye condition while maintaining effective symptom control.

Strategies to Reduce Your Xiidra Costs with Medicare

Beyond understanding your Medicare coverage, there are several strategies you can employ to potentially reduce your out-of-pocket costs for Xiidra. One approach is to carefully compare Medicare Part D plans during the annual enrollment period (October 15-December 7) to find a plan that offers more favorable coverage for this medication.

If you have limited income and resources, you might qualify for Extra Help, a Medicare program that helps pay for prescription drug costs. This program can significantly reduce your out-of-pocket expenses for medications like Xiidra. You can apply through the Social Security Administration.

For those taking multiple medications, reaching the catastrophic coverage phase more quickly can actually save money on expensive drugs like Xiidra in the later part of the year. In this phase, you'll pay significantly less (5% coinsurance or a small copay) for your medications.

Mail-order pharmacy options through your Medicare plan may offer savings on 90-day supplies compared to monthly fills at retail pharmacies. Additionally, asking your doctor about samples of Xiidra can sometimes provide temporary relief while you're working through coverage issues or waiting for assistance program approvals.

Conclusion

The cost of Xiidra with Medicare varies widely depending on your specific plan, coverage phase, and whether you qualify for additional assistance programs. While Medicare Part D and many Medicare Advantage plans do cover Xiidra, expect to pay between $100-$200 per month with typical coverage after meeting your deductible. For the most accurate information about your specific costs, check your plan's formulary, use the Medicare Plan Finder tool, or call your plan directly. Don't hesitate to discuss affordability concerns with your healthcare provider, as they may be able to suggest alternatives or connect you with assistance programs to make this important medication more accessible.

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This content was written by AI and reviewed by a human for quality and compliance.