Switching from Xiidra to Cequa
My doctor switched me from Xiidra to Cequa. At my most recent visit, I told him that I was still having to use lubricating eye drops often (almost every hour by the end of the day), so he wanted to experiment with switching me to a new prescription drop.
Although Xiidra has helped me tremendously and has been one of the biggest difference makers in improving my dry eyes and reducing inflammation with few side effects, he said that the sulfites in Xiidra can be irritating to some patients. By the end of the day, that’s how my eyes felt: irritated.
My results with Cequa
So he gave me a sample pack of Cequa to try. One of the biggest differences I noticed was in administering the drops. Although Xiidra helped me, it always stung a bit when I applied it to my eyes.
Cequa feels like pure water to me, and I have no stinging sensation. Also, I notice a difference at the end of the day. I am not having to apply drops quite as often. My eyes feel less irritated. In using Xiidra, I would administer drops when I woke up in the morning and around 5 p.m. I am following the same schedule with Cequa, and my eyes seem to feel better.
A problem: my insurance didn't cover it
After using the sample pack for about a week and with these positive results, I was ready to fill my prescription. The only problem was that my insurance did not cover Cequa. (It covers Xiidra). My doctor’s office had given me a coupon in case the price was outrageous, but when I went to the website listed on the coupon to activate it, the site said that the program was no longer available.
However, on the Cequa website, I did find another savings program. On it there were a couple of different savings options, one that allowed patients to pay a cash price of $80 for a one-month supply if a prior authorization is submitted and insurance denies it.
A jaw-dropping price
I was used to my insurance fully covering my Xiidra with my Xiidra coupon savings program, so $80 per month would be a change, but I was willing to pay it. So I dropped the prescription and coupon off at my pharmacy. Later, the pharmacist called me and said the coupon could not be used, because that drug did not require prior authorization through my insurance.
I asked how much it would be per month (as my insurance did not cover it), and she said it would be over $700 per month. My jaw dropped. That simply was not do-able. I would stick to my Xiidra if that was the case. I decided to go back to the pharmacy to pick up my prescription to see if I could figure out other options.
When I got there, another pharmacy representative entered in the coupon code, and it somehow brought the price down to a little over $300 per month. That was better but still not an option for me. She suggested calling my insurance company and seeing if they could somehow process a prior authorization so that I could use the $80-per-month option.
Calling my insurance company
I called my insurance company and explained everything to them. The representative said that I should call the appeals department, so I did so. The lady with appeals said that my doctor’s office would need to send over a prior authorization.
So I called my doctor’s office, and I spoke with a technician who kindly submitted the prior authorization for me. Instantly, while I was on the phone with the technician, my insurance company approved Cequa because I had already tried Xiidra (the medication it covered) for over a year.
I was ecstatic! I then called my pharmacy to check on the status there, and the pharmacist said that with my insurance approving it and with the savings card, it was covered in full and I wouldn’t have to pay anything. What a huge blessing!
Not giving up
This whole process of going back and forth to my pharmacy and making phone calls took several days of work and frustration. I honestly didn’t know what I was doing.
But I persevered and figured it out with the help of some very kind people. I am so grateful that I do not have to pay over $700 a month. Even though the Xiidra was irritating my eyes some, the fact that I tried it for over a year was what allowed me to end up getting the Cequa for free. I am so glad that I didn’t give up because it paid off!
Would you be interested in joining a live discussion with our CDE Health Leaders?
Join the conversation