How to Help Your Patients Save Money on Lacrisert: A Provider's Guide to Savings Programs

At $578–$691 per 60-count package without insurance, Lacrisert is one of the more expensive ophthalmic medications a patient can be prescribed. Cost is a significant adherence barrier — patients who cannot afford their medication simply stop using it. As the prescribing clinician, you have several tools at your disposal to help patients access Lacrisert at a manageable cost. This guide consolidates the most effective approaches.

Understanding Why Lacrisert Is So Expensive

There are several structural reasons for Lacrisert's high retail price:

No generic competition. There is no FDA-approved AB-rated generic for Lacrisert. Without generic competition, brand manufacturers face no price pressure at the pharmacy level.

Low prescription volume. A PMC study reported approximately 990 Medicare claims for Lacrisert in 2017. With a small patient base, manufacturing, distribution, and operating costs are spread over fewer units, driving up per-unit price.

Specialty product classification. Some pharmacy benefit managers (PBMs) classify Lacrisert as a specialty drug or Tier 4, leading to higher cost-sharing for patients.

Tool 1: Submit a Strong Prior Authorization on the First Pass

Most commercial insurers require prior authorization for Lacrisert. A well-documented first submission dramatically reduces denial rates and turnaround time. Your prior auth should include:

Diagnosis codes: ICD-10 H04.123 (dry eye syndrome bilateral), H16.231 (neurotrophic keratoconjunctivitis), or the most applicable code for the specific patient

Objective findings: Schirmer test scores (typically <5 mm/5 min for moderate-severe), corneal staining grade (Oxford or NEI scale), OSDI score, and tear film breakup time (TBUT)

Prior treatment history: Document the specific artificial tear products tried (brand, frequency, duration) and the clinical response (inadequate or intolerant). Many policies require documented failure of at least one OTC lubricant.

Clinical rationale: Explain why Lacrisert's sustained-release format is medically necessary for this patient versus a less expensive alternative — particularly for patients who cannot adhere to a frequent-drop regimen or have severe compliance barriers.

Tool 2: Appeal Denials With Clinical Evidence

If the initial prior authorization is denied, do not stop there. Denial rates for ophthalmic medications are high, but appeal success rates are also high when the appeal is clinically robust. For Lacrisert appeals:

Cite peer-reviewed literature supporting Lacrisert's efficacy in aqueous-deficient dry eye

Document why the insurer's preferred alternative therapy is not clinically appropriate for this specific patient

Request a peer-to-peer review with the insurer's medical director if the appeal is denied — this is the single most effective tool for reversing prior auth denials

Tool 3: Direct Patients to the Bausch + Lomb Patient Assistance Program

Bausch + Lomb offers a Patient Assistance Program (PAP) for uninsured or underinsured patients who meet income eligibility criteria. Eligible patients can receive Lacrisert at no cost. This is particularly relevant for uninsured patients, Medicare patients in coverage gaps, or patients with high-deductible plans.

Phone: 1-800-323-0000

Application: Requires physician signature. Your office can streamline this by keeping an application on file for new Lacrisert patients.

Processing time: Typically 2–4 weeks. Consider prescribing a bridge supply or a temporary alternative therapy while the PAP application is processed.

Tool 4: Recommend GoodRx or SingleCare for Uninsured or High-Copay Patients

For patients who are not PAP-eligible but lack insurance or face high copays, GoodRx brings the Lacrisert price down from ~$691 to approximately $578–$595. While this is still not cheap, it is meaningfully lower than the retail price and can make the medication accessible for patients who would otherwise forgo it. Post the GoodRx.com URL in your patient materials or print a card that patients can take to the pharmacy.

Tool 5: Optimize the Prescription for Insurance Coverage

Practical prescription-writing strategies can reduce insurance friction:

Write for a 90-day supply if the patient is on maintenance therapy. Many mail-order plans offer lower effective copays for 90-day fills.

Specify the indication on the prescription (e.g., "keratoconjunctivitis sicca, severe") to help the pharmacist identify the appropriate benefit and reduce adjudication errors.

Notify the pharmacy of the NDC: 24208-800-60. Some pharmacy systems default to a formulary alternative if the NDC is not specified.

Tool 6: Help Patients Find It in Stock Too

Cost is not the only barrier — availability is too. Even when a patient's insurance covers Lacrisert, finding a pharmacy that stocks it can be a significant obstacle. Recommend medfinder.com to patients. medfinder calls pharmacies near them to check which ones can fill the prescription — solving the availability problem while you solve the cost problem.