Restasis Patient assistance program
Complete a free online enrollment application to find out if you’re eligible to pay only $49 per month for your Restasis medication.Get started today
- Secure: Your personal and medical information is safe with us
- Convenient: We manage the whole process and we’re here to assist you
- Ongoing refills: We request your medication refills on your behalf
NiceRx works with your healthcare provider to help you access affordable medications directly from U.S. pharmaceutical companies.
An introduction to NiceRx(01:52)
Next steps after qualifying(00:38)
Uploading documents and billing(00:50)
SSN & billing information(00:33)
Medication delivery time(00:41)
How it works
Get started by filling out the online enrollment application to find out if you are eligible.
NiceRx verifies your eligibility for medication assistance and notifies you if you are qualified.
You may be required to submit further information and documents required by the pharmaceutical company which can be securely uploaded online.
Your application is created and sent to your doctor for signature. At this stage, you will be billed $49 and will not be billed again until you receive your first medication delivery.
Your application is sent to the pharmaceutical company. You will be billed again once you receive your medication. We handle the entire ordering process including requesting ongoing refills.
Your monthly Restasis cost savings if eligible
The below table illustrates your potential cost savings if you are eligible for the patient assistance program. Remember, with NiceRx you will only ever pay the flat monthly fee of just $49. You could save:
|Strength||Avg. monthly price at
a US pharmacy
|1 package of 30 vials Restasis 0.4ml||$261.42||$49.00||$212.42|
|1 bottle (5.5ml) of Restasis 0.05%||$571.00||$49.00||$522.00|
Am I eligible for the Restasis patient assistance program?
If you meet the eligibility criteria for Restasis assistance, you could receive your prescription without paying the full retail price. We review each Restasis assistance program application individually.
- I am a permanent, legal resident of the United States or Puerto Rico
- I am uninsured or my insurance doesn’t cover my medication
- I meet certain income eligibility requirements
How do I apply for the Restasis patient assistance program?
We remove the stress from applying for patient assistance programs. Our enrollment application is simple and straightforward to complete. The important part at this stage is to complete all required sections of the form. This means that you must let us know about any medications you’re taking, including Restasis. It’s crucial that you provide full details of both your healthcare provider, insurance, and your household income. This is required by the pharmaceutical manufacturers who ship your medication and must be completed to apply for the program.
If we think you may be eligible for Restasis assistance, we’ll handle the full application process and will seek to enroll you in the Restasis patient assistance program. Once you are enrolled in the program, we’ll also request your Restasis medication refills on your behalf for up to a full year.
Is NiceRx a Restasis coupons provider?
NiceRx is not a Restasis coupon, a Restasis discount card, or a Restasis copay card. We are a service provider that helps eligible individuals access the Restasis patient assistance program. We don’t offer printable Restasis manufacturer coupons, Restasis discounts, rebates, Restasis savings cards, trial offers, or free Restasis samples.
Can NiceRx help me get Restasis if I have insurance?
Our customer service representatives are on hand and available to discuss your personal situation and answer any questions you might have about the Restasis patient assistance program.
Remember, each application is reviewed individually as eligibility varies by program, meaning we may be able to help if your insurance company won’t pay for your Restasis medication, or you have a high copay or coinsurance responsibility. We may even be able to assist if you don’t have insurance.
How much is Restasis with insurance?
The exact cost of Restasis varies in line with your healthcare plan. To find out more, your healthcare provider or pharmacist will be able to calculate your copay with your current insurance.
How much does Restasis cost without insurance?
Restasis prices without insurance will vary depending on if you buy Restasis single-use vials or bottles of Restasis MultiDose. Prices will also vary by retailer. As a guide, you’ll pay around $390 for one 5.5 ml bottle of 0.05% Restasis MultiDose (approximately 30 doses).
What is Restasis?
Restasis ophthalmic emulsion is prescribed to help people increase their tear production. It’s used when people don’t produce enough tears because of a condition called keratoconjunctivitis sicca. Keratoconjunctivitis sicca (KCS), also called dry eye syndrome (DES) or chronic dry eye, is a condition that dries your eyes. It can be caused by inflammation in your eye that reduces your ability to produce tears. Tears are essential to lubricate your eyes.
KCS can make your eyes feel dry, itchy, scratchy, it can make them ache or burn, and make it feel as if you have grit in your eyes. It can result in damage to the eye, causing redness, blurred vision, and a discharge. This can make everyday tasks difficult, like reading or using electronic screens. If left untreated, KCS can cause lasting damage and, in rare cases, loss of vision.
The inflammation that leads to KCS can be caused by a range of issues, including allergies, vitamin A deficiency, wearing contact lenses, pregnancy, and laser eye surgery. It can also be caused by medications taken for other conditions, like antihistamines for allergies, blood pressure medications, antidepressants, and hormone replacement therapies.
Restasis treats KCS by reducing inflammation in your eyes, helping you naturally produce more tears. It comes as an emulsion (liquid) that you put into your eyes like an eye drop (as directed by the physician who prescribes it to you). You can either buy single use vials of Restasis, or a bottle with multiple doses called Restasis Multidose.
Restasis active ingredients
The active ingredient in Restasis is called cyclosporine. It reduces inflammation in your eye to help you produce more tears. Cyclosporine works by lowering the activity of a type of cell produced by your immune system called a T-cell, that’s involved in the inflammatory process.
Your immune system triggers inflammation to help protect your body from pathogens that can cause harm and to repair damage. Sometimes your immune system can trigger inflammation when it’s not needed, or for longer than it’s needed. In your eyes this can cause dryness and conditions like keratoconjunctivitis sicca (KCS). Cyclosporine disrupts a process inside the T-cells, reducing their ability to cause inflammation.
Restasis side effects & Restasis drug interactions
As with any medication, Restasis can cause side effects. Not everyone will experience the same side effects though, or any at all. The most common side effects caused by Restasis include:
- A burning feeling in the eye
- Discharge from the eye
- Eye pain and itchiness
- Redness in the eye
- Feeling like you have something in your eye
- Watery eye
- Visual disturbances, like blurring
In rare instances, Restasis can cause more serious side effects, including:
- An allergic reaction to the medication
- Eye injury (although this is caused by accidentally touching the eye with the vial/bottle when taking Restasis)
These aren’t all the side effects Restasis can cause. You can read more about Restasis side effects in the leaflet that comes with your medication. Talk to your doctor if you’re concerned about any side effects.
No medicines are known or thought to interact with Restasis. However, you should always tell your prescribing physician about all the drugs you’re taking, including any vitamins or dietary supplements.
Restasis warnings & precautions
Don’t take Restasis if you:
- Are allergic to the active ingredient cyclosporine
- Are allergic to any of the other ingredients in Restasis
Talk to your physician before taking Restasis if you:
- Are pregnant or are planning to get pregnant
- Are breastfeeding or are planning to breastfeed
- Are under 16 years of age
Be careful not to touch your eye with the vial/bottle when taking Restasis, as this can cause injury and contaminate your eye.
Don’t take Restasis whilst wearing contact lenses. Wait at least 15 minutes after taking Restasis before putting contact lenses in.
Restasis can cause blurred vision which may impair your ability to drive or use machinery. You should avoid driving or using machinery if your vision is blurred.
*Qualifying persons may obtain medications directly from patient assistance programs without any out-of-pocket cost (or for less than $49 per medication). However, our monthly flat rate of just $49 per medication spares you the hassle of tracking down the different programs and filling out all the required paperwork for each program.
Enrollees enjoy a full-service solution, as NiceRx assists them and their physicians with the entire process. We prepare all required documents for the physician to sign, help enrollees manage all prescription refills, monitor eligibility criteria, and maintain enrollment.
**If you do not receive medications because you were determined to be ineligible for the prescription assistance by the applicable pharmaceutical companies and you have a letter of denial, we will refund any fees you paid toward medications for which you did not qualify to receive prescription assistance (“Refund”).
To receive a refund, you must send the letter of denial to us by fax to 888-517-7444, or by e-mail to [email protected] within 30 days of your receipt of such letter. The Refund is your sole and exclusive remedy for any fees you may wish to dispute.