a young woman putting in eye drops

Dry eyes can make life miserable. The eyes feel as though there were sand in them, and they tire easily. People may complain of blurred vision. Until recently, the first-line treatment for dry eyes was tear substitutes to lubricate the eyes. An anti-inflammatory medicine, cyclosporine (Restasis), can be helpful although it may take a long time to act. There is a mechanical approach, LipiFlow, which warms and compresses the eyelids to get the meibomian glands to secrete protective oils. What about the new drug Xiidra? How well does it work for dry eyes?

Searching for Relief for Dry Eyes:

Q. I read recently about LipiFlow treatment to provide temporary relief for dry eyes. However, my ophthalmologist quoted the treatment cost at $1000 per eye.

I am now using a new prescription medication for dry eyes. Since it is new, the prescription cost is outrageous-$500 for a 30 day supply. It’s called Xiidra. Patients are given a trial supply before purchasing.

I’ve found it works immediately. In comparison, Restasis takes months to make any difference.

New Drug Xiidra Is Pricey:

A. The FDA approved lifitegrast (Xiidra) last year as the first in a new class of drugs for dry eyes. It works by affecting the immune system to reduce inflammation (Pflugfelder et al, Journal of Ocular Pharmacology and Therapeutics, Jan/Feb. 2017). More than 2,000 adults participated in randomized controlled trials of these eye drops. Reviewers for The Medical Letter on Drugs and Therapeutics concluded that it is safe and modestly effective (JAMA, April 11, 2017).

Adverse Effects of Xiidra:

Xiidra may cause blurred vision, eye irritation, pain, itching and a peculiar taste in the mouth. The biggest drawback for this new approach is the cost. If insurance companies won’t approve or pay for these eye drops, most people will find it hard to afford them.

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  1. JB

    My MD prescribed Restasis. It was denied by Anthem. The rejection letter said to try Xiidra. That was also later rejected by Anthem. (I can’t make this up). I decided to pay for it because my eyes were so troublesome. The pharmacy suggested getting a manufacturer’s coupon. I did it on my phone while I stood there at the counter. It’s for free for the first month. $10 per month after that. I’ve tried it. Have mixed opinions. The stinging is crazy. It’s almost counterintuitive to put something in my eye that hurts like that. The next thing is that moments after using it, it seems to expel any of that white mucous from my eye. I have to use regular drops to clear it all out. Then I have slightly blurry vision for 20 minutes… can be resolved with more eye drops. So, I’m kind of limited to taking it at night… don’t have that kind of time during the day when I don’t need my eyes. Torn. Is it supposed to be this way?

  2. Martha
    Meridian, MS

    My insurance won’t cover Restasis and I can’t afford $6,000.00 a year out of pocket for it. Anybody have suggestions for alternative?

  3. Diana

    I have the most difficult time getting the drops out of the plastic vial. My doctor told me I could use a vial more than once (stored properly). However, the medication get lodged in the end and no amount of pressing, shaking seems to get it to move so can be dispensed. Sometimes even a freshly opened vial has this happen. I cannot be the only one with this issue?

    • Ann

      This works for me. Hold the vial sideways, and tap on the top of it until all the liquid is lying horizontal. You are basically getting the air bubble out, and then it comes out easily,

  4. marie

    I enjoyed reading all the comments. So far, I am just using refresh optive, but itchy eyes is still bad. I am using blephadex, but not seeing any relief. I have had prokera treatment in both eyes, that helped with me seeing, but floaters are still really bad, making every thing blurry, cloudy (dark).

    Have not tried xiidra yet. Don’t think I could afford it….. but I sure like reading people’s comments. Really helpful!!!!

  5. carmen s

    I have been using ziidra for about a two weeks, it has helped tremendously, but I had to cut the use to once a day, the metallic taste had gotten so bad, but once I started pinching my tear ducts, that got better, however, it gave me severe stomach reflux pain, so I took a break from it, and the pain stopped. I am going to try to keep using it, it has helped.

  6. Tim
    Charlotte NC area

    I received from my doctor the “XiiDRA iiNSIDER” card and brochure “for people with commercial insurance”. The brochure states “Pay $0 for your first 30 days for XiiDRA, Then $10 every month for as long as you take it.”

    In fine print, it states that the card will reduce the monthly refill cost up to a maximum of $250. This suggests to me that there is a pharmacy that has a retail price of $260.

    My question is, which pharmacy has a retail price of $260? But I already know the answer is no pharmacy has this price.

    So, my second question is what are the retail prices at the big 6 pharmacies: Rite Aid, Safeway, Walmart, Walgreens, CVS, and Target?

    • Stef
      Monterey CA

      Hi Tim – The Walgreens Pharmacy in Seaside CA charges $599 for a 30-day supply. I used the trial coupon provided by my Ophthalmologist so that this first supply was free. While I hope it works, I won’t be able to afford continued use after this 30-days, as my Blue Cross plan only covers $100.00 toward the cost of the prescription, leaving me with $499 out of pocket.

  7. Paul
    Reston, VA

    I tried using Xiidra for the first time yesterday morning. I did not feel immediate relief .. in fact it was quite the opposite later on in the day. By early afternoon my eyes became more irritated. By early evening it got worse. My only relief was a good night’s sleep and woke up the next morning feeling better. I am reluctant to keep trying the drops. I have tried everything else from A to Z including Restasis. All my tear ducts are either plugged or cauterized. I’ve been living this nightmare for the past 25 years. I am so disappointed that Xiidra did not work for me.

  8. Joy

    I’ve used Restasis for a couple of years and had good results with it. Two different Opthamologists had mentioned to me that you can pop the top of the vial back on and seal it to be used completely. I’ve gotten 2 1/2 to 3 days use from one vial which makes a prescription go a lot further and saves money. Just put the open vial in an empty Rx bottle till it’s finished. I have also tried Xiidra and the vial cannot be resealed (the company made sure of that).

  9. Cindy

    My friends and I have found that 1 capsule of flax seed oil a day completely eliminates dry eyes and it is good for you. My optometrist said he learned about flax seed oil at one of his seminars. He confirmed that it works to prevent dry eyes. It in inexpensive.

    • Donna
      Washington state

      I have been using Xiidra for more than a month and it helped immediately. First drop I actually had tears running down my cheek! I had used Rastasis for years and still suffered with dry eyes. I also take 3 fish oil and 1 flaxseed oil capsules a day. My ophthalmologist said I have severe dry eyes so was really pleased with Xiidra. I have discovered you can use a top from a Refresh Plus ampule by stretching it to fit on the Xiidra. (Use an empty Xiidra ampule to stretch it) But you still can’t get 2 days our of 1 ampule of Xiidra. I think it is thicker and they do not put as much in the ampule to make it last. I can usually get at least 3 drops out of one ampule, though. So far I am pleased with it, but the expense is terrible. My insurance company picks up a lot and I can only get a 1 month supply so far at a time and I do have a co-pay.

    • Patty

      Sorry to be so dumb but do you take the flax seed capsule orally or do you open it and use it as eye drops? If you take it orally, how quickly does it work?

  10. Mary

    I have tried both of these drops,and couldn’t tell any improvement.
    Went back to over the counter drops. Even tho my insurance paid for most of the cost,I still thought it was a waste of money for both parties.
    Price is ridiculous

  11. laalaa0220
    rocky river, oh

    It is called GREED. Simple as that!!!

    And what goes around comes around REMEMBER THAT!!!💀💀💀💀💀💀

  12. Sarah

    I had an eye drop similar to Restasis, but made by a compounding pharmacy. It worked great until for some reason the pharmacy changed the formula and it was too painful to use. I tried Restasis and couldn’t tolerate it either. Just to let you know, I got a humidifier and it’s not as good as the original drops, but helps a lot. There’s no way I could afford $500/month for Xiidra.

  13. AG
    Wheeling, WV

    I had been having trouble with dry eyes for at least a year, especially with one eye. I recently had cataract surgery which required usage of 3 different prescription eye drops for a few weeks. It has been almost 3 months since the surgery, and I now have very little problem, or none, without using eye drops. I’m not sure if this is the result of the surgery, the prescribed eye drops, or both. I can now read for long periods with much better acuity and comfort

  14. Wendy
    Rochester NY

    I started using Xiidra about a month ago. It works well for me, although the bad taste is sometimes quite offputting. Luckily, my insurance is covering it for $25 a prescription. I also use Systane Balance drops several times a day. It’s so nice not to have bloodshot eyes all the time.

  15. Pat
    Abilene, Texas

    I certainly agree with all the previous comments about the cost of pharmaceuticals. BigPharma spends a fortune on political campaigns, lobbying Congress, and the FDC. My other gripe is the manner in which these eye drops are sold………the packaging is very wasteful, not to mention not environmentally appropriate.

    The individual vials are plastic and cause the same environmental problems as any other plastic containers. Undoubtedly, this type of packaging must be more costly than eye drops in bottles. I recently had cataract surgery, which required my using several prescription eyedrops for several weeks’ the prescriptions were, however, in multi-dose bottles. I also find the individual vials much more difficult to use, not to mention wasteful.

  16. Ruth
    Oxford, Ohio

    I started taking Vitamin B12 (one tablet per day) and found, that as an unexpected benefit, my dry eyes got significantly less dry. Still have to use moistening (non-prescription) eyedrops, but *much* less frequently (once or twice a day), less frequently if I’m not spending too much time in front of the computer screen.

  17. Peggy

    I was using restasis for a period of about a year with limited results.

    I had the Lipiflo procedure for $800 total and it helped. Then I was prescribed Xiidra and told to stay on Restasis until I used up my supply. Xiidra works the best for me. It burns but my doctor said to use a small drop of Refresh Plus first and then put the Xiidra in. It also helps to close off the tear ducts by pressing them with fingertips for one minute after drops are inserted. This cuts down the aftertaste significantly. The insert directions actually give this direction.

    • Ann

      If you store the Xiidra in the fridge it cuts down the burning. Your eyes respond to the coldness instead of what causes the burning.

  18. Rmg

    I’ve been taking Xiidra for several months, after Restasis stopped improving my blepharitis condition. There has been a slow, but noticeable improvement, although the cost is very high. Xiidra comes in cute little plastic capsules, with each capsule having only enough fluid for one drop in each eye, and you then discard the capsule (there is usually one or two drops left over, so if you miss getting a drop in, you have a second shot at it).

    But I need to take it twice a day, so the cost mounts rapidly. List price, without insurance, is over $500 for a month’s supply. My insurance wouldn’t cover any of it, but after I appealed, they now cover 50% of the cost (better than nothing). So if you do the math, it comes out to each DROP costing over $4, twice a day for both eyes.

    It has a bitter taste to it, which gets into your nose and mouth through the tear ducts located in your lower eye lids, located closest to your nose. So you need to put your index and middle finger over the little duct holes, put the drops in and then wait a least a minute before removing your fingers. Works every time. I’m continuing with Xiidra in the hopes I will see further improvement over time (there are apparently no other drugs, other than Restasis, for blepharitis).

    My ophthalmologist is pleased with the results so far, and I have not had any appreciable side effects except some initial irritation of the eyes which gradually faded over a few weeks. One commenter noted here that it was not possible for a few drops of medicine to cost so much, but she seems to have forgotten that it can cost millions to develop, test and market a major new drug, so that’s what you’re paying for.

  19. Angela

    I have been using castor oil drops in my eyes at night. It’s been working well so far.

    • Virginia
      Truckee, CA

      The use of castor oil in the eye is interesting to me. No one has ever mentioned that to me before. Xiidra has had a limited impact on my DED. Someone else mentioned flax seed oil but, did not say if they were using it orally or as an eye drop. Would be curious to know.

  20. Birder
    South Pasadena, Ca

    I agree. The Xiidra works great. Immediate relief however the price is outrageous. I’ve been using GoodRx which “lowered” the price to anywhere from $432 to $450. I’ve used several pharmacies by transferring my prescription each time i need a refill. I also use only half a vial each time, put the cap over it, place in the bag foil it comes in and storing it in a clean pill container so it stretches to two months. Suggested by by MD.

  21. Susan

    I have Keratoconus, and dry eye commonly accompanies this disease. I take krill oil and astaxanthin and find that minimizes dry eye issues to the point that I do not need drops or prescription drugs.

  22. Kathi

    I had taken restasis for almost a year with no improvement in my dry eyes. And I developed extremely bloodshot eyes and crustiness. The ophthalmologist didn’t believe it was related to the med, but, I stopped it on my own and within two days the symptoms were gone. However my vision was still blurry and it was hard to read for any length of time.

    When Xiidra came out, I was hesitant due to cost and side effects. Plus, I am always leery of new meds in the market. But frustration with my vision set in, and I couldn’t enjoy life. So I tried using the drop in one eye to see if it worked and if I would get a terrible taste in my mouth.

    I was amazed at the result, in one day. I can see again and read as much as I want. No more film across my eyes. My ophthalmologist had told me I could use each individual dropper up to 3 days as long as I didn’t touch the tip and stored it properly. So, that is what I do now. After I put my drops into my eye, I carefully slip the dropper back into the packet. Also, the only side effect I noticed was that my eyes watered TOO much.

    So now I only use the drops at night. That way my eyes are fine when I awake, and they don’t tear excessively throughout the day. On occasional days, they are drier so I will use the drops in the morning also. But then I often have tears running down my cheek. This is a wonderful medication. Well worth any amount of money.

  23. EllenM
    St Louis

    I’ve been using Restasis for a number of years. Although I don’t really notice any more tears, my Dr says it is working. Tried Xiidra for a month (was free). It really burned, so I didn’t continue using it after the free trial. Didn’t notice any difference while using it. Both are very expensive.

  24. Midge

    I tried Xiidra (at a prohibitive cost) hoping to find relief but I experienced all the side effects mentioned, Especially red bloodshot eyes and extremely blurred vision. Make sure you have a trial sized container from your Doctor before investing hundreds of dollars on something you can’t use.

  25. Robin

    I use both Restasis and Xiidra, and it has helped some. But dry eyes are a constant battle to overcome. The dryness leads to a periodic irritation that just takes time to heal (2-3 days each time). I also had the Lipiflow procedure, paid the $1000 (for two eyes, not per eye) and got no noticeable benefit. My insurance pays for the Xiidra, so my cost is $40 per box of 50 vials. Each vial has about 3 drops in it, so a vial doesn’t go very far, given that I use one drop per eye, twice a day. I’m glad to know that the Xiidra isn’t BAD for me, because it has helped some.

  26. Nanette
    North Carolina

    I started using Xiidra two months ago after my eyes became so dry that they were swollen. It did work immediately to relieve the discomfort and swelling. The side affect of a odd taste in my mouth is tolerable. The medication is very expensive but the first month free discount was helpful. I considered not continuing it because of the cost but it turns out that my insurance deductible was met so my cost is about $80. Hope that in a month or two I can reduce usage to once a day and save some cost. I also use Systane balance drops once or twice during the day. I hope that the company can reduce the cost at some point.

  27. Roxane

    Beyond ridiculous that big Pharma charges obscene amounts for these and other medications. No one will convince me that a tiny bottle costs anywhere near $500 to make and with the huge deductibles many insurance co now make people pay until drugs are even covered (my insurance got rid of all copays) they are even more unaffordable. Shame on this country, shame on big pharma, shame on the deplorable state of health insurance in this country.

    • SNH

      It’s not the cost of making drugs that determines the price. It’s the cost of inventing and developing it and doing clinical trials. Research scientists don’t work for free.

  28. ML
    Buffalo, NY

    I was using the Restasis for a year and I was feeling a difference. Of course my prescription was only $30/month taking advantage of the manufacturer monthly $20 rebate. And my insurance costs were viable. But then my insurance carrier, Independent health decided to make it a Tier 2 drug and I had to cover 35% of the drug cost and it went up to $140/month. There was no way I could afford that so I had to stop. And I had wanted to try the Xiidra but with the out of pocket cost this high no way can I afford that. So I still use over the counter drops just about every 20 min. while at work on a computer.

    Why are these rugs so high in cost? I get that the manufacturer wants to recoup the dollars spent on clinical trials and research but you cannot get those costs back charging the public this much. Something has to give.

    • Donna

      My ophthalmologist told me to never use an eye drop from a bottle because they all have a preservative in them. So I use Refresh Plus ampules and TheraTears Lubricant eye-gel if my eyes feel especially dry.

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