Xiidra costs vary widely depending on your Medicare plan and pharmacy, but most beneficiaries pay between $0 and $50 per month after their plan's coverage kicks in

Xiidra is a prescription eye drop for dry eye disease. What you pay depends on three things: whether your specific Medicare plan covers it, which tier (cost level) your plan places it on, and which pharmacy you use. Medicare Part D (prescription drug coverage) is what covers Xiidra, not Part B. If you have a Medigap or Medicare Advantage plan with drug coverage, your costs work differently than Original Medicare with a separate Part D plan.

The price before insurance is roughly $60 to $70 per bottle, but you will not pay that amount. Instead, you pay your plan's copay or coinsurance. Most plans place Xiidra on Tier 3 or Tier 4, which means moderate to higher cost-sharing. After you meet your deductible (usually $505 in 2024, though this changes yearly), you typically pay a fixed copay—often $35 to $50 per fill—or a percentage of the cost, whichever your plan uses.

Key Takeaways

  • Xiidra is covered by most Medicare Part D plans, but the amount you pay depends on which tier your plan assigns to it and your plan's specific copay structure.
  • You will need to meet your Part D deductible before cost-sharing begins, though some plans waive the deductible for certain drugs.
  • Prices vary by pharmacy, so calling ahead to compare costs at different locations can save you money even within the same plan.
  • If your plan's copay is too high, you can ask your doctor about generic alternatives or request a coverage exception through your plan's appeals process.
  • Your costs may change if you switch plans during the annual enrollment period (October 15 to December 7), so comparing drug costs across plans is worth doing each year.

How Medicare Part D covers Xiidra

Part D plans use a formulary—a list of covered drugs—and place each drug on a tier. Xiidra appears on most formularies, but not all. Tier 1 drugs cost the least; Tier 5 drugs cost the most. Xiidra usually lands on Tier 3 or Tier 4. A Tier 3 copay might be $35; a Tier 4 copay might be $50 or more. Some plans use coinsurance instead, meaning you pay a percentage (often 25% to 33%) of the drug's cost after your deductible.

Before any copay applies, you must meet your annual deductible. In 2024, the standard Part D deductible is $505, though some plans have lower deductibles or no deductible at all. Once you hit that amount out of pocket, your plan begins to pay its share. After you reach the deductible, you enter the "initial coverage" phase, where you and your plan split costs according to your tier.

If your out-of-pocket costs reach $8,850 in 2024 (the "catastrophic threshold"), you move into catastrophic coverage and pay only a small copay for the rest of the year. Xiidra is unlikely to push you into catastrophic coverage on its own, but if you take multiple expensive medications, it can contribute.

What to expect at the pharmacy counter

When you fill a Xiidra prescription, the pharmacy will run your insurance and tell you the copay amount. That amount is what you owe that day. The plan pays the rest directly to the pharmacy. If you use a mail-order pharmacy through your plan, the process is the same, though delivery takes 7 to 10 days.

Prices can differ between pharmacies even within the same plan. A large chain pharmacy, an independent pharmacy, and a mail-order service may all be in-network, but their negotiated rates with your plan may vary slightly. Calling two or three pharmacies to compare copays takes five minutes and can save you money, especially if you are filling multiple prescriptions.

Some pharmacies offer discount programs (like GoodRx or SingleCare) that let you pay a lower price by not using insurance. If your copay is very high, it is worth checking whether a discount card would cost less. However, using a discount card means the cost does not count toward your deductible or out-of-pocket maximum, so this strategy works best early in the year or if you have already met your deductible.

Xiidra costs if you have Medicare Advantage with drug coverage

Medicare Advantage plans (Part C) often include prescription drug coverage built in, rather than requiring a separate Part D plan. Xiidra coverage and costs work similarly—your plan has a formulary, a deductible, and copays or coinsurance—but the rules can differ from Original Medicare plans. Some Advantage plans have lower copays for Xiidra; others have higher ones. A few plans may not cover Xiidra at all.

The best way to know your exact cost is to call your plan's customer service number (on your insurance card) and ask: "Is Xiidra on my formulary, and what is my copay?" They can tell you when ready. You can also log into your plan's website and search the formulary yourself, though calling is faster and more reliable.

Medigap plans and Xiidra costs

Medigap (supplemental insurance) does not cover prescription drugs. If you have Original Medicare plus a Medigap plan, you still need a separate Part D plan to cover Xiidra. Your Medigap plan will not reduce your Xiidra copay. However, Medigap does cover some of the costs that Part D does not—such as coinsurance in the coverage gap—so your total out-of-pocket costs may be lower than with Part D alone.

When you have both Medigap and Part D, the two plans coordinate their payments. Your Part D plan pays first according to its formulary and tier rules. Then Medigap may cover some remaining costs, depending on which Medigap plan you chose. This layering can reduce what you pay at the pharmacy, so it is worth understanding both plans' rules.

Ways to lower your Xiidra costs

If your copay feels too high, talk to your doctor. Xiidra is a brand-name drug, and there is no generic version yet. However, your doctor may prescribe a different eye drop that is cheaper or covered at a lower tier. Cyclosporine (Restasis) is another prescription option for dry eye; some plans cover it at a lower cost. Over-the-counter artificial tears are not the same as Xiidra but may help some people and cost far less.

You can also request a coverage exception from your plan if your doctor believes Xiidra is medically necessary and your plan denies it or places it on a high tier. Your doctor submits the request, and the plan reviews it. If approved, your copay may be reduced or the drug may be covered without prior authorization. This process takes 24 to 72 hours in urgent cases.

During the annual enrollment period (October 15 to December 7), you can switch to a different Part D plan or Medicare Advantage plan. Comparing plans side by side shows which ones cover Xiidra at the lowest copay. The Medicare Plan Finder tool on Medicare.gov lets you enter Xiidra and see costs across all plans in your area. Switching plans costs nothing and can save hundreds of dollars per year if you take expensive medications.

Understanding the coverage gap and catastrophic phase

After you and your plan spend $8,550 combined on covered drugs in 2024 (the "initial coverage limit"), you enter the coverage gap, sometimes called the "donut hole." In the gap, you pay a higher percentage of the drug cost—currently 25% for most drugs. This continues until your out-of-pocket spending reaches $8,850, at which point catastrophic coverage begins.

In catastrophic coverage, you pay only a small copay (about $11 for generic drugs and $33 for brand-name drugs in 2024) for the rest of the year. Xiidra, as a brand-name drug, would cost you about $33 per fill once you reach catastrophic coverage. For people who take Xiidra year-round, this phase can provide meaningful savings in the final months of the year.

Frequently Asked Questions

Does Medicare cover Xiidra without a copay?

No. Medicare Part D covers Xiidra, but you pay a copay or coinsurance based on your plan's tier. Some plans may waive the copay for certain drugs, but this is rare for Xiidra. Your plan's customer service can tell you whether your specific plan offers any copay waiver.

What if my plan does not cover Xiidra?

If your current plan's formulary does not include Xiidra, you have two options: request a coverage exception from your plan (your doctor submits this), or switch to a different plan during the annual enrollment period. Most plans do cover Xiidra, so switching is usually possible and may be worth it if Xiidra is the right medication for you.

Can I use a GoodRx coupon instead of my Medicare insurance?

You can, but it usually is not the best choice. GoodRx coupons bypass insurance, so the cost does not count toward your deductible or out-of-pocket maximum. This works only if your copay is higher than the GoodRx price and you have already met your deductible. Call your pharmacy to compare both prices before deciding.

Will my Xiidra copay change next year?

Yes. Medicare plans change their formularies and copays every January. During the annual enrollment period, you can compare plans and switch if a different plan offers a lower copay for Xiidra. Even if you stay with the same plan, the copay amount may increase.

How do I find out my exact copay for Xiidra?

Call your plan's customer service number (on your insurance card) and ask for the copay for Xiidra. You can also search your plan's formulary online if you have a login. The pharmacy can also tell you the copay when you call to fill the prescription.