Your Patients Can't Find Cequa — Here's How to Help

You've prescribed Cequa (Cyclosporine ophthalmic solution 0.09%) for a patient with dry eye disease, and now they're calling back because their pharmacy doesn't have it. This scenario plays out regularly in ophthalmology and optometry practices across the country — not because of a drug shortage, but because of the unique access challenges Cequa presents in 2026.

This guide provides practical steps you and your staff can take to help patients find and fill their Cequa prescriptions efficiently.

Current Cequa Availability

Cequa is not in shortage. Sun Pharmaceutical Industries continues to manufacture and distribute the medication. However, retail pharmacy availability is inconsistent for several interconnected reasons:

• Low stocking at chain pharmacies: CVS, Walgreens, and similar chains often don't keep Cequa in their standard inventory due to low fill volume relative to shelf space
• Insurance-driven fill failures: Prior authorization requirements, step therapy mandates, and formulary exclusions mean many Cequa prescriptions never reach the dispensing stage — which reinforces low stocking
• Specialty distribution: Sun Pharma directs much of Cequa's distribution through PhilRx, its specialty pharmacy partner, rather than traditional retail channels
• High acquisition cost: At $850-$917 AWP per 30-day supply, pharmacies face financial risk stocking a medication that may sit unsold

For a detailed analysis of these factors, see our clinical brief: Cequa shortage — what providers need to know in 2026.

Why Patients Can't Find Cequa

Understanding the patient experience helps frame why this requires practice-level intervention. When a patient takes a Cequa prescription to their regular pharmacy, they commonly encounter:

1. "We don't carry that" — The pharmacy simply doesn't stock Cequa
2. "Your insurance won't cover it" — A real-time claim rejection at the pharmacy counter, often requiring prior authorization
3. "We can order it, but it'll take a few days" — The pharmacy can get it but doesn't have it on hand
4. "You might want to call your doctor" — The pharmacist defers back to the prescriber

Each of these scenarios results in a patient leaving without their medication and calling your office. A proactive approach at the point of prescribing can prevent most of these callbacks.

What Providers Can Do: 5 Practical Steps

Step 1: Route Prescriptions to PhilRx or a Known Specialty Pharmacy

The single most reliable way to ensure Cequa gets to your patient is to prescribe directly to PhilRx, Sun Pharma's specialty pharmacy partner. PhilRx:

• Maintains reliable Cequa inventory
• Handles insurance navigation and prior authorization support
• Processes manufacturer copay cards and savings programs
• Ships directly to the patient

If your practice doesn't already have a PhilRx prescribing workflow, contact your Sun Pharma representative to set one up. Having this pathway established saves significant time per patient.

Step 2: Initiate Prior Authorization at the Point of Prescribing

Don't wait for a pharmacy rejection to start the PA process. Most payers require step therapy documentation (artificial tears → generic Cyclosporine 0.05% → Cequa), so capturing this in your clinical note at the time of prescribing is essential.

Document in your encounter note:

• Dry eye disease diagnosis with severity assessment
• Previous treatments tried and duration/outcome (artificial tears, generic Cyclosporine 0.05%, etc.)
• Clinical rationale for Cequa specifically (e.g., inadequate response to 0.05% formulation)

Sun Pharma provides a Prior Authorization and Appeals Kit with template letters and clinical documentation guides. Having these templates pre-loaded in your practice's PA workflow reduces turnaround time.

Step 3: Apply the Manufacturer Copay Card at the Point of Prescribing

For commercially insured patients, the Cequa Co-Pay Program can reduce the patient's copay to as low as $0. Rather than having patients figure this out on their own at the pharmacy, provide the copay card information during the office visit.

Keep printed copay cards or digital access information at checkout. Your staff can hand the patient the card and explain how to present it at the pharmacy alongside their insurance card.

For Medicare patients, manufacturer cash discount pricing may be available through PhilRx when the Part D plan does not cover Cequa.

Step 4: Use Medfinder to Check Local Availability

When a patient prefers to use a local pharmacy rather than specialty mail-order, Medfinder for Providers can help identify which nearby pharmacies have Cequa in stock. This takes the guesswork out of the process and prevents wasted trips.

Your front desk or technician staff can run a quick Medfinder search while the patient is still in the office and provide a pharmacy recommendation before they leave.

Step 5: Bridge With Samples When Possible

Prior authorization and specialty pharmacy routing can take several days. If your practice has Cequa samples, providing a bridge supply ensures the patient can start treatment immediately rather than waiting for the access process to resolve.

Contact your Sun Pharma representative about sample availability for your practice.

Alternative Medications to Consider

When Cequa access proves too difficult or cost-prohibitive for a specific patient, alternative prescribing options include:

• Generic Cyclosporine 0.05%: Best formulary coverage; ~$90/month; appropriate as first-line cyclosporine
• Vevye (Cyclosporine 0.1%): Newer water-free formulation; ~$1,070/month; may have different formulary positioning depending on the plan
• Xiidra (Lifitegrast 5%): Non-cyclosporine mechanism; ~$1,000/month; useful for cyclosporine non-responders
• Tyrvaya (Varenicline nasal spray): Neurostimulation approach; ~$930/month; for patients who cannot tolerate topical ophthalmics

For a patient-friendly comparison to share, see alternatives to Cequa.

Workflow Tips for Your Practice

Incorporating these strategies into your practice workflow can significantly reduce patient callbacks and improve Cequa fill rates:

• Create a Cequa prescribing checklist for your technicians/scribes that includes: insurance verification, PA initiation, copay card provision, and pharmacy routing (PhilRx vs. local)
• Designate a staff member to handle specialty pharmacy coordination and PA follow-up — this prevents tasks from falling through the cracks
• Set up electronic prescribing to PhilRx if your EHR supports it
• Bookmark Medfinder for Providers on practice computers for quick availability checks
• Stock patient education materials about Cequa access, including the manufacturer savings programs and what to expect at the pharmacy

Final Thoughts

Cequa access challenges in 2026 are manageable with the right practice-level systems in place. The medication is available — the bottleneck is in the space between prescribing and dispensing. By proactively routing prescriptions to specialty pharmacies, initiating prior authorization early, and equipping patients with savings tools, you can dramatically improve your patients' experience with Cequa.

For real-time availability checking, visit Medfinder for Providers. For the clinical supply briefing, see Cequa shortage — what providers and prescribers need to know in 2026.