Why Cost Matters for Trifluridine Adherence

When you prescribe Trifluridine 1% ophthalmic solution for herpes simplex keratitis, you're prescribing a medication that requires frequent dosing (up to 9 drops per day), refrigerated storage, and strict adherence over 14 to 21 days. If your patient can't afford to fill the prescription, none of that matters.

Trifluridine's cost is a real barrier. The retail cash price for a single 7.5 mL bottle runs $300 to $400 — a significant out-of-pocket expense for patients without adequate prescription coverage. As a prescriber, you're in a unique position to help patients navigate the financial landscape before they leave your office.

This guide covers the savings options available for Trifluridine and practical strategies for building cost conversations into your workflow.

What Patients Are Paying

Here's the cost landscape for Trifluridine in 2026:

• Average retail (cash) price: Approximately $363 for a 7.5 mL bottle
• With discount coupons (e.g., SingleCare): As low as $201
• With insurance (Medicare Part D / commercial): Varies by plan; most cover generic Trifluridine with a specialty or preferred tier copay
• Brand-name Viroptic: Rarely stocked; may not be covered by insurance when available

For a medication used to prevent corneal scarring and vision loss, cost-driven non-adherence is particularly concerning. A patient who uses drops less frequently than prescribed — or doesn't fill the prescription at all — risks treatment failure and potential permanent vision damage.

Manufacturer Savings Programs

Unlike many brand-name medications, generic Trifluridine does not have a dedicated manufacturer savings card. The original brand, Viroptic, has been off-patent for years, and current generic manufacturers (Sandoz, Apotex) do not offer direct-to-patient discount programs.

However, Pfizer RxPathways may offer assistance for eligible patients who need help affording their medications. RxPathways connects patients with various Pfizer assistance programs and can be reached at 1-844-989-PATH (7284) or at pfizerrxpathways.com.

Patient Assistance Programs (PAPs)

For patients with financial hardship, the following resources can help identify assistance options:

• NeedyMeds (needymeds.org) — A comprehensive database of patient assistance programs, discount drug cards, and disease-specific assistance.
• RxAssist (rxassist.org) — A database of manufacturer and foundation patient assistance programs.
• RxHope (rxhope.com) — Connects patients with pharmaceutical company assistance programs.

These programs typically have income eligibility requirements and may take time to process. For urgent prescriptions like Trifluridine (where treatment delay risks vision), consider bridging strategies while PAP applications are pending.

Coupon and Discount Cards

Prescription discount cards are the most immediate way to reduce out-of-pocket costs for patients paying cash or with high-deductible plans. The major options for Trifluridine include:

• SingleCare: Currently offers prices as low as approximately $201 — nearly 45% off the retail price.
• GoodRx: Aggregates coupons from multiple sources; prices vary by pharmacy location.
• RxSaver, Optum Perks, BuzzRx: Additional coupon platforms that may offer competitive pricing depending on the pharmacy.

Clinical tip: Encourage patients to compare prices on multiple platforms before filling. Prices can vary significantly between pharmacies — even within the same chain — and between different coupon providers. The savings can be $50 to $150 per fill.

Important: Discount cards cannot be combined with insurance. Patients should compare their insurance copay to the discount card price and use whichever is lower.

Generic Alternatives and Therapeutic Substitution

Trifluridine itself is the generic — there's no cheaper generic option below it. However, when cost or availability is a significant barrier, therapeutic substitution is worth considering:

Ganciclovir Ophthalmic Gel 0.15% (Zirgan)

• FDA-approved for acute herpetic keratitis
• Dosed 5 times daily (vs. 9 for Trifluridine), which may improve adherence
• Cash price is typically higher ($500-$700), but may have better insurance coverage depending on the plan
• May be more readily available at pharmacies due to broader distribution

Oral Antivirals as Adjunctive or Alternative Therapy

• Acyclovir (generic): Significantly cheaper (often under $20 with coupons for a course of oral tablets)
• Valacyclovir (generic Valtrex): Also affordable, with better oral bioavailability than Acyclovir
• Oral antivirals alone may be appropriate for some presentations, particularly stromal keratitis or as suppressive therapy
• The Herpetic Eye Disease Study (HEDS) demonstrated the value of oral Acyclovir in reducing recurrence

When making therapeutic substitution decisions, weigh the severity of the epithelial disease, patient compliance capacity, insurance formulary placement, and overall cost burden.

Insurance Navigation Tips for Your Team

A few practical steps your office can take:

• Verify formulary coverage before prescribing. If you have access to the patient's insurance formulary (through your EHR or e-prescribing system), check whether Trifluridine is covered and on which tier. This takes seconds and can save the patient a frustrating pharmacy visit.
• Submit prior authorization proactively. Some plans require PA for Trifluridine. If your EHR flags this, submit the PA before the patient leaves or have staff handle it same-day. For an acute infection, emphasize the urgency.
• Know your appeal process. If coverage is denied, a peer-to-peer review or letter of medical necessity explaining the risk of corneal scarring and vision loss is often successful.
• Consider samples. If your office stocks Trifluridine samples (uncommon for generics, but possible for brand Zirgan), this can bridge a patient while financial assistance is arranged.

Building Cost Conversations into Your Workflow

Many ophthalmologists and optometrists don't routinely discuss medication cost with patients. Here's how to make it seamless:

At the Point of Prescribing

• Mention the approximate cost: "This medication runs about $300-$400 without insurance. Let's make sure we find the most affordable option for you."
• Ask directly: "Do you have prescription drug coverage? Any concerns about the cost of medications?"
• Have staff provide a printed list of coupon resources (SingleCare, GoodRx) with each Trifluridine prescription.

At Follow-Up

• Ask whether the patient was able to fill the prescription. Non-fill rates for expensive medications are higher than most providers assume.
• If the patient didn't fill it or is rationing doses, address it — treatment failure from under-dosing can lead to complications that are far more expensive to treat.

Direct Patients to Resources

• Medfinder for Providers — Help patients locate Trifluridine availability at nearby pharmacies, especially during supply disruptions.
• Your patient-facing savings guide: How to Save Money on Trifluridine

Final Thoughts

Trifluridine is a critical medication for preserving vision in patients with herpes simplex keratitis. But a prescription that doesn't get filled — because of cost, availability, or both — doesn't help anyone. By familiarizing yourself with the savings landscape, building cost awareness into your prescribing workflow, and connecting patients with resources proactively, you can improve adherence and outcomes.

For availability information and provider resources, visit Medfinder for Providers.