With weak therapeutic evidence, notable side effects and multiple alternative lower-cost treatments available, how did Restasis become a blockbuster drug? The simple answer: Marketing. For years, Allergan has run extensive advertisements for Restasis inducing plan beneficiaries — like yours — to use Restasis. As a plan administrator, your first step should be to determine the amounts your Plan is spending on Restasis.
Cost of restasis eye drops without insurance discounts for restasis eye drops
Blocking coverage may also make more sense, since many PBMs simply rubber-stamp approvals and will fail to ensure that your customized Prior Authorization criteria are actually satisfied. The list prices for the drugs are comparable. Shire says it offered substantial but unspecified discounts to compete with Allergan's Restasis. In its lawsuit, Shire alleges Allergan has "compelled and coerced" Part D plans to limit access to Xiidra by offering discounts on both Restasis and the company's heavily used glaucoma drugs if the plans would favor Restasis on their formularies.
After an administrator of several Part D plans abandoned a tentative agreement to cover Xiidra and decided against putting the drug on the plans' formularies, the lawsuit says, Shire asked how it could gain coverage.
It’s Time To Limit Your Coverage of Restasis
As a result of Allergan's "exclusionary agreements," Shire's lawsuit says, top Part D plans either refused to put Xiidra on their drug formularies or placed it in a less favorable position. Shire says the moves mean patients have to file difficult appeals in order to get Xiidra or pay higher copays for the drug than for Restasis.