Cost Is the Biggest Adherence Barrier for Natacyn

When you prescribe Natacyn (Natamycin 5%) for a fungal eye infection, you're prescribing the only FDA-approved ophthalmic antifungal available in the United States. But you may also be prescribing a significant financial burden. At $400-$700 per 15 mL bottle with no generic alternative, Natacyn's price creates a real adherence barrier — and when patients can't afford to fill or continue their prescription, outcomes suffer.

This guide provides practical strategies for helping your patients access Natacyn at a manageable cost, from manufacturer programs to insurance navigation and therapeutic alternatives.

What Your Patients Are Paying

Understanding the cost landscape helps you anticipate patient concerns:

• Cash price: $400-$700 per 15 mL bottle (one bottle typically covers a full 14-21 day treatment course)
• No generic available: There is no FDA-approved generic Natamycin ophthalmic product in the U.S., eliminating the most common cost-reduction pathway
• Insurance variability: Coverage is inconsistent. Many plans require prior authorization due to Natacyn's specialty drug classification. Some plans cover it under the medical benefit (particularly when dispensed in-office) rather than the pharmacy benefit
• High deductible impact: Patients with high-deductible health plans may face the full cash price early in the year before meeting their deductible

For a medication that must be used frequently (every 1-2 hours initially) to treat a sight-threatening condition, even a partial financial barrier can lead to dose-skipping or premature discontinuation.

Manufacturer Savings Programs

Alcon Laboratories, the sole manufacturer of Natacyn, offers limited patient support:

• Alcon Patient Assistance Program: May be available for eligible uninsured or underinsured patients. Patients or providers can contact Alcon directly at 1-800-757-9195 to inquire about eligibility and enrollment.
• No widely advertised copay card: Unlike many brand medications, Alcon does not currently offer a widely promoted copay savings card specifically for Natacyn. This is likely because the drug's small patient population and specialty status don't support a traditional copay card program.

Proactive step: Have your staff contact Alcon's patient services line before the patient leaves your office. Getting the process started immediately prevents delays in treatment initiation.

Coupon and Discount Cards

Third-party discount programs can provide meaningful savings for patients paying cash:

• GoodRx — May show discounts at participating pharmacies. Savings vary significantly by location and pharmacy.
• SingleCare — Another discount card option. Patients should compare prices across platforms, as the best price varies.
• RxSaver, Optum Perks, BuzzRx — Additional coupon card providers worth checking. For a specialty product like Natacyn, not all platforms will have negotiated pricing.

Important caveat: Discount cards cannot be combined with insurance. They're most useful for uninsured patients or when the cash price with a coupon is lower than the insured copay (which can happen with high-deductible plans).

For a comprehensive overview of patient savings options, direct patients to our guide on how to save money on Natacyn.

Insurance Navigation Strategies

Your office can play a critical role in getting Natacyn covered:

Prior Authorization

Most insurers require prior authorization for Natacyn. Streamline this process by:

• Submitting the PA request the same day you write the prescription
• Including clinical documentation: culture results (or pending cultures), slit-lamp findings, photos if available
• Emphasizing that Natacyn is the sole FDA-approved ophthalmic antifungal — there is no formulary alternative that is FDA-approved for this indication
• Noting the sight-threatening nature of the condition and urgency of treatment

Medical vs. Pharmacy Benefit

If the patient's pharmacy benefit denies or creates high cost-sharing:

• Consider dispensing Natacyn from your office dispensary if you have one — this may allow billing under the medical benefit
• Administer the first dose in-office and bill under an office visit, then explore whether ongoing treatment can be classified as part of medical management
• Contact the insurer to determine which benefit pathway provides better coverage

Appeals

If coverage is denied:

• File a formal appeal emphasizing medical necessity and the lack of FDA-approved alternatives
• Include supporting literature on the standard of care for fungal keratitis
• Request a peer-to-peer review with the plan's medical director

Generic Alternatives and Therapeutic Substitution

When cost is an absolute barrier and the patient cannot access Natacyn at any manageable price, providers may consider therapeutic alternatives:

Compounded Ophthalmic Antifungals

• Compounded Voriconazole 1% eye drops — Broadly used off-label for fungal keratitis. May cost $50-$200 through compounding pharmacies. Note: Clinical trials (MUTT I) showed Natamycin was superior to Voriconazole for Fusarium keratitis.
• Compounded Amphotericin B 0.15-0.5% eye drops — Another polyene antifungal. Generally reserved for Natamycin-resistant cases or when Natacyn is unavailable. May cost $30-$100 through compounding pharmacies.
• Compounded Fluconazole 0.2% eye drops — Less commonly used; may be an option for Candida infections.

Important considerations with compounded alternatives:

• None are FDA-approved for ophthalmic use
• Quality depends on the compounding pharmacy
• Use USP 797-compliant compounding pharmacies for sterile preparations
• Document your clinical rationale for using a compounded product

When to Use Alternatives vs. Natacyn

As a general framework:

• Prefer Natacyn when available and affordable — it's the standard of care with the strongest evidence base
• Consider compounded Voriconazole for Aspergillus or mold keratitis, or when Natacyn is unavailable/unaffordable (but note inferior outcomes for Fusarium)
• Reserve compounded Amphotericin B for resistant cases or as adjunctive therapy

Building Cost Conversations into Your Workflow

Integrating cost discussions into your clinical workflow improves adherence and outcomes:

1. Disclose cost upfront — When prescribing Natacyn, tell the patient: "This medication costs $400-$700 without insurance. Let's make sure we find the best price and get insurance to cover it before you leave today."
2. Assign a staff member to handle Natacyn-specific insurance and assistance inquiries. Given the drug's cost and niche status, having someone familiar with the process saves time for everyone.
3. Keep Natacyn in your office dispensary if feasible. This solves both the availability problem (patients don't have to search for a pharmacy that stocks it) and may offer a more favorable reimbursement pathway.
4. Partner with a specialty pharmacy that regularly stocks Natacyn. Having a go-to pharmacy referral streamlines the process for patients.
5. Provide resources — Direct patients to Medfinder for help finding Natacyn in stock, and to NeedyMeds (needymeds.org) and RxAssist (rxassist.org) for patient assistance program information.
6. Follow up on fills — Have your staff confirm the patient actually filled the prescription within 24-48 hours. If they didn't, the reason is often cost or availability — both of which you can help address.

For additional provider resources, visit Medfinder for Providers.

Final Thoughts

Natacyn's status as the sole FDA-approved ophthalmic antifungal makes it both indispensable and financially challenging for patients. The lack of a generic, combined with inconsistent insurance coverage and limited manufacturer savings programs, means the prescribing provider often becomes the patient's best advocate for affordability.

By proactively addressing cost — submitting prior authorizations promptly, connecting patients with assistance programs, and having a plan for when Natacyn is unaffordable — you can reduce the risk of treatment abandonment and protect your patients' vision.

For more provider-focused resources on Natacyn, see our guides on Natacyn shortage information for providers and helping patients find Natacyn in stock.