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 with our help.Get Started Now
Secure: Your personal and medical information is safe with us
Convenient: Your medication is delivered straight to your door
Ongoing refills: Your medication is refilled automatically
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. The pharmaceutical company provides your medication for free and you only pay our service fee.
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
With our assistance, you could access the Restasis patient assistance program and obtain your medication for free. We only charge a flat monthly fee of $49 per medication for our services.
|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 Restasis patient assistance?
We review each Restasis enrollment application individually to determine if you are eligible. Each assistance program has its own eligibility criteria and the factors considered by most programs are:
- 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?
Our process makes it as easy as possible to apply for the Restasis patient assistance program. Begin by completing the enrollment application form on our website. Tell us about any medications that you are taking, including Restasis, your healthcare provider, your insurance plan, and your household income. This information is required by the pharmaceutical manufacturers who will supply the medication, so it is important to make sure this information is accurate and up to date.
We will review the information that you have provided to determine whether you are eligible for patient assistance. If we can pre-qualify you for assistance, NiceRx will handle the full enrollment process on your behalf. If you are approved by the pharmaceutical company, you will typically start receiving your medication in 6 – 8 weeks.
Is NiceRx a Restasis coupons provider?
NiceRx is not a Restasis coupon, Restasis discount card, or Restasis copay card provider. We do not offer Restasis manufacturer coupons, Restasis discounts, rebates, Restasis savings cards, trial offers, or free Restasis samples. We are a service provider that helps eligible individuals access their medication directly from the U.S. pharmaceutical company.
Can NiceRx help me if I have insurance?
NiceRx may be able to help you if:
- You have a high copay or coinsurance responsibility for Restasis
- Your insurance company will not pay for your Restasis prescription
- Your healthcare plan does not cover your medication
- You do not have insurance
Please apply online to find out if we can help you.
How much does Restasis cost without insurance?
Without insurance, Restasis costs will vary depending on where you buy the medication as prices will vary by retailer. As a guide, Restasis ophthalmic emulsion 0.05% will cost around $330 for 30 emulsions.
How much does Restasis cost with insurance?
The copay for Restasis will depend on the terms of your healthcare plan. Your healthcare provider or pharmacist will be able to calculate your copay with your current insurance. Contact them to find out more.
What is Restasis?
Restasis is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Allergan, Inc.
Restasis eye drops are used to treat chronic dry eye disease that may be caused by inflammation. It is a topical immunomodulator indicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctual plugs.
What doses of Restasis are available?
Restasis is available as an ophthalmic emulsion, containing cyclosporine 0.5mg/mL.
Instill one drop of the ophthalmic emulsion twice a day in each eye, every 12 hours. The single-use vial has to be thrown away after you use it as the vials don’t contain any preservatives in it.
Wait at least 15 minutes before using artificial tears, or any other eye drops. Do not touch the dropper onto any surface, including the eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an eye infection. Also, to avoid potential eye injury and contamination, be careful not to touch the vial tip to your eye.
Do not use this medicine while wearing contact lenses. Contact lenses may be reinserted 15 minutes following the administration of Restasis eye drops. Store at room temperature away from moisture and heat. Do not freeze. Keep the bottle tightly closed when not in use.
Always speak with a healthcare professional for medical advice or about any changes to your dose so they can monitor and evaluate your condition.
Restasis active ingredients
The active ingredient of Restasis is cyclosporine.
Restasis side effects
The most common side effects of Restasis in clinical trials include:
- Ocular burning sensation
- Eye redness
- Discharge, watery eyes
- Eye pain, foreign body sensation
Your doctor will assess the benefits of using Restasis against your risk of side effects. Patients are encouraged to report negative side effects or adverse reactions of Restasis to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Restasis drug interactions
There is currently no data for Restasis interactions with other medications. Tell your healthcare provider about all the medicines you take, including prescription drugs and over-the-counter medicines, vitamins, and herbal supplements.
You should not use Restasis if you:
- Are allergic to the active ingredient cyclosporine
- Are allergic to any of the other ingredients in Restasis
Talk to your doctor before using Restasis if you:
- Are taking any of the medications that could interact with Restasis
- Are pregnant or are planning to become pregnant
- Are breastfeeding or are planning to breastfeed
Restasis is the trademark brand name for cyclosporine manufactured by Allergan, Inc. A generic version of cyclosporine is not available. Generic drugs are generally cheaper than brand-name drugs, but you can still find Restasis savings through NiceRx.
*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 the different programs and filling out all the required paperwork for each program. Subject to medication availability.
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.
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.