Comprehensive medication guide to Nepafenac including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$60–$80 copay for Nevanac on most plans; approximately 80% of commercial plans cover it; prior authorization may be required; coverage for Ilevro (0.3%) varies by plan.
Estimated Cash Pricing
$370–$481 retail for brand Nevanac or Ilevro; as low as $321–$330 with GoodRx or SingleCare coupons per 3mL bottle (no generic available as of 2026).
Medfinder Findability Score
72/100
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Nepafenac is a prescription ophthalmic NSAID (nonsteroidal anti-inflammatory drug) used to treat pain and inflammation associated with cataract surgery. It is available as Nevanac (0.1% suspension) and Ilevro (0.3% suspension), both manufactured by Harrow Eye. Nepafenac is a prodrug — it is converted to its active form (amfenac) inside the eye after topical application.
FDA-approved since 2005 (Nevanac) and 2012 (Ilevro), nepafenac is used for a short, defined course: starting the day before surgery, on the day of surgery, and for two weeks after. It is not a controlled substance and requires a standard prescription. No FDA-approved generic is currently available in the United States.
In the European Union, Ilevro also carries an approved indication for reducing the risk of postoperative macular edema in diabetic patients undergoing cataract surgery — a use sometimes applied clinically in the U.S. for high-risk patients.
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Nepafenac works through a unique prodrug mechanism. When instilled into the eye, nepafenac rapidly penetrates the cornea — approximately 6 times faster than older NSAIDs like diclofenac. Once inside the eye, ocular tissue hydrolase enzymes convert nepafenac to its active form, amfenac, which is a potent inhibitor of both COX-1 and COX-2 cyclooxygenase enzymes.
By blocking COX enzymes, amfenac prevents the production of prostaglandins — the inflammatory mediators responsible for post-surgical pain, swelling, redness, and the risk of cystoid macular edema (CME). This inhibition occurs throughout both the anterior and posterior segments of the eye, making nepafenac effective for managing inflammation from the cornea all the way to the retina.
Systemic absorption is very low following topical administration. Studies show nepafenac provides more complete and longer-lasting inhibition of prostaglandin synthesis compared to older topical NSAIDs — more than 6 hours versus approximately 3 hours for diclofenac — which explains how the 0.3% Ilevro formulation achieves effective control with just one daily dose.
0.1% — ophthalmic suspension
Nevanac; 1 drop three times daily starting 1 day before cataract surgery, on surgery day, and for 14 days post-op
0.3% — ophthalmic suspension
Ilevro; 1 drop once daily starting 1 day before cataract surgery, on surgery day, and for 14 days post-op; additional drop 30-120 min before surgery
As of 2026, nepafenac (Nevanac and Ilevro) is NOT on the FDA's official drug shortage list. Harrow Eye distributes both products through established wholesale channels including McKesson and AmerisourceBergen. However, localized availability gaps are common for several reasons: no generic exists, so fewer manufacturers produce it; pharmacies stock it in limited quantities because demand clusters around surgical schedules; and the high retail price ($370–$481) means some pharmacies minimize inventory unless demand is confirmed.
Patients who plan ahead and use the right tools generally have no trouble finding nepafenac. The key strategies are: request your prescription at your pre-op appointment (1–2 weeks before surgery), check multiple pharmacy types including independent and specialty pharmacies, and use tools to search available pharmacies without calling each one.
Use medfinder to search for Nepafenac at pharmacies near you — medfinder calls pharmacies in your area and texts you which ones have your medication in stock, saving hours of phone calls before your cataract surgery.
Nepafenac is not a controlled substance and carries no DEA scheduling restrictions. Any licensed prescriber with appropriate scope of practice for ophthalmic medications can write a prescription for Nevanac or Ilevro. No special DEA registration or additional state permits are required.
Providers who commonly prescribe Nepafenac include:
Telehealth is generally not used to initiate Nepafenac prescriptions, as the medication is part of the perioperative management of cataract surgery — which requires in-person surgical assessment and procedure. Post-operative follow-up may be managed via telehealth in some practices, but slit-lamp examination for corneal monitoring requires an in-person visit.
No. Nepafenac (Nevanac and Ilevro) is NOT a controlled substance and is not listed under any DEA drug schedule. There are no special prescribing restrictions, no triplicate prescription requirements, and no limitations on which licensed healthcare providers can write a prescription for it.
Any licensed physician, optometrist (in most states), nurse practitioner, or physician assistant with prescriptive authority and appropriate scope of practice can prescribe Nepafenac. It can be called in, faxed, or sent electronically to any pharmacy — no special handling is required. Patients do not need to present a physical prescription to fill it.
While nepafenac is not a controlled substance, it is a prescription-only medication and cannot be purchased over the counter. It requires a valid prescription from a licensed healthcare provider.
Most patients tolerate the standard 14-day post-surgical course well. Common side effects include:
Contact your ophthalmologist immediately if you experience sudden vision changes, worsening eye pain, visible blood in the eye, or signs of eye infection.
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Bromfenac (Prolensa, generic)
Once-daily NSAID eye drop; generic available at $80–$200; starts day after surgery (vs. day before for Nepafenac)
Ketorolac (Acular, Acuvail, generic)
Most affordable option at $15–$50 generic; dosed 4x daily; preservative-free formulation available; widest pharmacy availability
Diclofenac ophthalmic (generic)
Affordable generic at $20–$60; dosed 4x daily; long clinical track record in post-cataract care
Prefer Nepafenac? We can find it.
Topical corticosteroid eye drops (prednisolone, dexamethasone)
moderateCombination increases risk of delayed wound healing; commonly co-prescribed but requires monitoring at follow-up visits
Other topical ophthalmic NSAIDs
moderateUsing two NSAID eye drops simultaneously is not recommended; increased risk of corneal complications without additional benefit
Anticoagulants and antiplatelet drugs (warfarin, aspirin, clopidogrel, apixaban)
moderateMay increase risk of ocular bleeding (hyphema) around surgery; discuss with surgeon before procedure
Oral NSAIDs (ibuprofen, naproxen, aspirin)
minorIncreases overall NSAID burden; generally low clinical significance given minimal systemic absorption of topical nepafenac, but should be discussed with physician
Nepafenac (Nevanac and Ilevro) is a proven and effective NSAID eye drop used for a short, critical period around cataract surgery. Its unique prodrug design enables superior intraocular penetration and broad anti-inflammatory coverage throughout the eye — helping protect your vision during the recovery period.
The main challenges patients face are the high retail price ($370–$481 without insurance or coupon) and occasional pharmacy stock gaps. These challenges are manageable with the right approach: request your prescription early, use a GoodRx or SingleCare coupon, or ask about the patient assistance program if cost is a significant barrier. If one pharmacy doesn't have it, others nearby likely do.
If you're having difficulty finding Nepafenac in stock, medfinder helps patients find which pharmacies near them have their medication in stock — so you can fill your prescription before your surgery date and start your recovery on the right track.
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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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