Restasis eye drops price jumps 200%
Dear Dr. Roach: My wife, who’s 72, has had very dry eyes for a long time, so she uses Restasis (cyclosporine emulsion 0.05%) eye drops. Her co-pay (after meeting the deductible) last year was around $150 for a threemonth supply. This year, it is around $450 (only a small change in the deductible with the same part D insurance provider), and she has not yet reached the “donut hole.” So, why did the outof-pocket cost jump 200% in one year for these eye drops? Also, my pharmacist says that now there is a generic brand for Restasis, but Medicare has not yet approved it. Do you know the name for this generic brand? Wouldn’t Medicare save money, too, by approving the generic brand for Restasis?
C.K.D.
Answer: In general, health insurance companies in the United States are for-profit entities. Their primary concern is making money for their shareholders. They do that by getting as much money as practicable from their customers (you) and by paying as little as possible to providers (like me). They don’t want people like you to go to a different company, and they don’t want people like me to stop accepting their insurance, so they try to balance all these factors and charge, what they judge, is the optimum amount for profits. Part D insurance is specifically for medications, but the issues are similar.
Cyclosporine (that’s the generic name) ophthalmic emulsion, used to treat dry eyes that have not responded to other treatments does have a generic brand available, which was approved by the FDA (not by Medicare) in Feb. 2022.
The retail price for the generic is about 1/4, or less, of the retail cost for the brand-name Restasis; however, insurance companies may or may not pass those savings onto you. It is usually substantially less money to the consumer to use generics when available. Her ophthalmologist must write the prescription so that a generic is allowed.
Medicare just recently became able to negotiate prices with drug companies in some circumstances: It is not clear what the effect of the law will be on prescription prices to the consumer.