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Thread: Is Restasis covered by your insurance? Feedback Please!!

  1. #1

    Is Restasis covered by your insurance? Feedback Please!!

    Hi, I just got a prescription for Restasis and I filled it today but the pharmacy told me that my insurance doesn't cover it and I'll have to pay out of pocket (which is $140 a month!). The thing is I have very good insurance that has always covered all of my prescritions unless they are cosmetic ones. I dont understand how they cannot cover a drug like Restasis when it is one of very few treatment options for a chronic disease. I have ocular rosacea by the way, so chances I'll have dry eye symptoms for my whole life.

    I wanted to know if other users of Restasis have it covered by their insurance??

    Also, do you think I could convince my insurance company to pay for it?

  2. #2

    No Insurance

    I have no insurance but if you are not covered you can try making it last longer by being careful about using it. I am making mine last 2 months, I just put in one drop in each eye twice a day and then save it for the next day. Also Costco chain is $108. Also if you go to the Restasis site you can get a free tray after buying 7 trays. I checked my insurance coverage and if I got the prescription coverage I would have a copay of $40. That would be with Neighborhood health in Boston. Still makes no sense why they would not cover it.

  3. #3
    Join Date
    Jan 2006
    Location
    Western WA State
    Posts
    1,259
    When I used Restasis Insurance first classified it as a lower tier med, which meant a co-pay of about $25. Later, the insurance changed their tune and made it an upper tier med with a co-pay of $50.
    Every day with DES is like a box of chocolates...You never know what you're going to get.

  4. #4
    My insurance does cover it. It is covered under the higher $40 copay only because there isn't a generic of it. I was actually worried they wouldn't cover it because it could be argued that what I am experiencing is a side effect of Lasik, which is not covered by my insurance. If I were you I would call your insurance to protest it as your doctor felt this was the best treatment for your diagnosed condition.

  5. #5
    mine covers it, i have to pay a copay of $35. i have cigna.

  6. #6
    Join Date
    May 2007
    Location
    Arizona
    Posts
    20
    I have blue cross blue shield and my co-pay is 25 dollars.

    ~Kyle

  7. #7
    Join Date
    Mar 2005
    Location
    United States
    Posts
    119
    The thing is I have very good insurance that has always covered all of my prescritions unless they are cosmetic ones. I dont understand how they cannot cover a drug like Restasis when it is one of very few treatment options for a chronic disease.
    Sorry to hear that your insurance does not cover Restasis. It's surprising because it has been available for some time and it isn't an experimental drug. You could have your doctor write to the insurance company explaining exacting what you said, that it is one of very few treatment options for a chronic disease.

    Here is a site that might help: appealing health insurance denials

  8. #8

    Restasis burning

    You might try calling the member service rep on the card. It could just be a foul up. I have several months supply I am not using if anyone wants to pay the postage you can have them.
    Elaine

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