Comprehensive medication guide to Besivance including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$75 copay depending on plan; Besivance is covered by approximately 80% of commercial insurance plans and 50% of Medicare Part D plans. Prior authorization required for approximately 30% of ACA and 80% of Medicaid enrollees. The Bausch + Lomb Access Program reduces the copay to as little as $25 for eligible commercially insured patients.
Estimated Cash Pricing
$230–$350 at retail for a single 5 mL bottle of Besivance 0.6% (a full 7-day course); no generic available. With GoodRx coupons, prices drop to approximately $133–$226; SingleCare offers prices starting at approximately $204 at select pharmacies.
Medfinder Findability Score
55/100
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Besivance (besifloxacin 0.6% ophthalmic suspension) is a brand-name prescription antibiotic eye drop manufactured by Bausch + Lomb. It was approved by the FDA on May 28, 2009, and is indicated for the treatment of bacterial conjunctivitis — commonly called pink eye — in adults and children aged 1 year and older.
Besifloxacin is a fourth-generation fluoroquinolone antibiotic developed exclusively for ophthalmic use. Unlike systemic fluoroquinolones (such as ciprofloxacin or levofloxacin tablets), besifloxacin has no oral or IV counterpart — it was designed from the ground up for eye infection treatment. It is formulated with DuraSite, a mucoadhesive polymer delivery system that keeps the medication on the ocular surface for up to 12 hours per dose.
The standard treatment course is one drop in the affected eye(s) three times daily, spaced 4–12 hours apart, for 7 days. One 5 mL bottle provides a complete course of treatment for one or both eyes. No generic version of Besivance is currently available; patents are estimated to extend through November 2030.
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Besivance kills bacteria by simultaneously inhibiting two essential enzymes: DNA gyrase (topoisomerase II) and topoisomerase IV. Both enzymes are critical for bacteria to replicate their genetic material and divide. When besifloxacin blocks both enzymes at once, bacterial DNA breaks down irreparably, causing rapid cell death. This makes besifloxacin bactericidal — it actively kills bacteria rather than merely slowing their growth.
Unlike older fluoroquinolones that primarily targeted DNA gyrase, besifloxacin has relatively balanced activity against both enzymes. This dual-target inhibition raises the genetic barrier to resistance — bacteria would need simultaneous mutations in two separate genes to develop meaningful resistance, which is much less likely than the single mutation required to resist older agents.
The DuraSite formulation gives Besivance its characteristic gray-white, gel-like appearance. When instilled, the mucoadhesive polycarbophil polymer adheres to the conjunctival surface and slows drainage of the medication from the eye, extending besifloxacin's contact time to up to 12 hours and enabling effective three-times-daily dosing.
0.6% (6 mg/mL) — ophthalmic suspension
Standard adult and pediatric dose (ages 1+): 1 drop in affected eye(s) 3 times daily, 4–12 hours apart, for 7 days. One 5 mL bottle per full treatment course.
Besivance is not on the FDA's official Drug Shortage Database as of 2026, but many patients experience difficulty filling their prescription at local pharmacies. The medication scores a findability rating of 55 out of 100 — meaning it is available nationally but patients frequently encounter localized out-of-stock situations.
The stocking challenge stems from Besivance's brand-only status (no generic), high retail price ($230–$350 per bottle), and variable demand patterns for bacterial conjunctivitis treatment. Pharmacies stock it conservatively, and when a cluster of prescriptions arrives, shelves empty quickly. Specialty pharmacies near ophthalmology practices and Walgreens (a participating Bausch + Lomb Access Program pharmacy) tend to have more reliable supply.
If you're having trouble locating Besivance, medfinder can call pharmacies near you to check current stock, so you don't have to spend hours on hold.
Besivance is not a controlled substance, which means any licensed prescriber can write a prescription without special DEA registration requirements. It is routinely prescribed across multiple specialties and clinical settings.
Ophthalmologists
Optometrists (in most states, with therapeutic prescriptive authority)
Primary care physicians (family medicine, internal medicine)
Pediatricians (Besivance is approved for patients 1 year and older)
Nurse practitioners (NPs) and physician assistants (PAs)
Urgent care providers
Telehealth platforms including Teladoc, MDLive, and Sesame can diagnose bacterial conjunctivitis via video visit and prescribe Besivance electronically. Telehealth is a fast and convenient option for patients with pink eye, with visits typically costing $25–$75 and taking 15–20 minutes.
No. Besivance (besifloxacin ophthalmic suspension) is not a DEA-scheduled controlled substance. It is a standard prescription antibiotic eye drop. Any licensed healthcare provider — including physicians, nurse practitioners, physician assistants, optometrists (in most states), and telehealth providers — can prescribe Besivance without any special DEA registration requirements.
Because Besivance is not a controlled substance, there are no legal limits on the number of refills, no restrictions on electronic prescribing, and no special storage requirements beyond standard pharmaceutical storage conditions (59°F–77°F, protected from light). Patients can fill their prescription at any licensed pharmacy and may receive their prescription via telehealth.
Besivance is generally well-tolerated. Side effects, when they occur, are usually mild and localized to the eye. The following were reported in approximately 1–2% of patients in clinical trials:
Conjunctival redness (most common, ~2%)
Temporary blurred vision after instillation (normal — resolves in 1–3 minutes due to DuraSite formulation)
Eye pain or burning/stinging upon instillation
Eye irritation (foreign body sensation)
Itchy eye (pruritus)
Headache
Severe allergic reaction: hives, difficulty breathing, swelling of face/lips/tongue/throat — stop using and seek emergency care
Worsening eye infection not improving after 2–3 days — contact your doctor
Superinfection with resistant organisms on prolonged use beyond 7 days
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Moxifloxacin (Vigamox)
Fourth-generation fluoroquinolone eye drop; most similar to Besivance in mechanism and spectrum; generic available for $15–$40; approved for all ages including infants.
Ciprofloxacin ophthalmic (Ciloxan)
Second-generation fluoroquinolone eye drop; widely stocked generic under $10; effective for most common bacterial conjunctivitis pathogens.
Tobramycin eye drops (Tobrex)
Aminoglycoside antibiotic; generic available under $20; preferred for Pseudomonas coverage or fluoroquinolone allergy cases.
Gatifloxacin (Zymaxid)
Fourth-generation fluoroquinolone eye drop; generic available; broad-spectrum coverage similar to Besivance.
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Other ophthalmic eye drops
minorWait at least 5 minutes between instilling Besivance and any other eye drop medications to prevent washing out and ensure adequate absorption of each agent.
Contact lenses
moderateDo not wear contact lenses during Besivance treatment or while signs/symptoms of eye infection are present. Lenses can absorb preservatives and may worsen the infection.
Systemic fluoroquinolones (oral/IV)
minorNo known clinically significant interaction due to minimal systemic absorption from topical ocular use. Disclose all medications to your prescriber.
Besivance is a clinically effective, well-tolerated antibiotic eye drop for bacterial conjunctivitis. Its fourth-generation fluoroquinolone profile, dual-target mechanism, and DuraSite delivery system make it a strong choice for patients who need broad-spectrum coverage or have had prior treatment failures with older antibiotic eye drops.
The main practical challenges are cost and availability. At $230–$350 per bottle, Besivance is one of the more expensive antibiotic eye drops available. Patients should explore the Bausch + Lomb Access Program (as low as $25 for commercially insured patients), GoodRx coupons (~$133–$226), or the Patient Assistance Program for uninsured/underinsured individuals. Since no generic exists until at least 2030, cost management through these programs is essential.
If you've been prescribed Besivance and your pharmacy doesn't have it in stock, medfinder can call pharmacies near you to find which ones have it available — saving you the time and frustration of calling pharmacies yourself.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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