Does your employee need a Restasis prescription? Here’s how to know if your company medical insurance can cover the Restasis cost.
Nearly half of all American adults struggle with dry eyes regularly.
Restasis is one of only two medications that can treat this medical issue. So, it’s likely that one of your employees will need this drug now or in the future.
Unfortunately, because of the Restasis cost, many people avoid this medication. Read on to learn what makes this drug so expensive and how to help your dry-eyed employees afford it.
Why Would an Employee Need Restasis?
For the occasional red eye, many people can rely on allergy medication or artificial tears to ease their pain. However, some people suffer from a chronic version of this common irritation.
People with certain medical problems can develop Chronic Eye Disease. For example, people over 50 are more prone to get it. These patients may constantly suffer from dry, itchy eyes.
Without treatment, this condition can cause blurred vision and other eye-related problems. Of course, this can affect your employee’s ability to work.
At first glance, Restasis may just seem like fancy eye drops. However, this drug functions differently than over-the-counter alternatives.
OTC eye drops may temporarily help dry eyes. Unfortunately, they can also make the eyes dependent on the artificial tears.
Restasis, on the other hand, helps the eyes produce their own tears. It also reduces inflammation, which is often the underlying cause of the eye problems. But the Restasis cost may keep people from getting this treatment.
No Generic Alternative
A generic drug contains the same ingredients and provides the same benefits as a name brand drug. Pharmaceutical manufacturers can only make the alternatives when the period of exclusivity ends.
The period of exclusivity allows drug manufacturers to recoup the money they spent on research and development.
Restasis also goes by “cyclosporine.” It has no approved generic equivalent since it is still in its FDA-sanctioned period of exclusivity.
That means that Allergan can drive up the Restasis cost and nobody can challenge them with a lower price.
However, this only applies to the United States. Patents and other pharmaceutical laws are much different around the world. So, Canadian pharmacies can make Restasis cost much less than their American counterparts.
How Allergan Kept Its Exclusivity
You may ask yourself the following question: I’ve been seeing Restasis ads forever, so how are they still exclusive?
The Journal of the American Medical Association reported that Allergan used a few shady tactics to keep their exclusive rights to this drug. The major pharmaceutical company gave the rights for Restasis to the Saint Regis Mohawk Tribe.
In turn, the Native American tribe will exclusively license the rights back to Allergan.
This move has drawn legal challenges, but that may take years to sort out in the courts. In the meantime, Allergan will continue to exclusive rights and keep driving the Restasis cost up.
For your employees with chronic dry-eye, this could mean that it will be years before they can afford their prescription unless your insurance covers the cost.
Why Should You Help Employees Afford Restasis?
As a business owner or manager, it’s important to meet your employee’s needs. This applies even when it comes to being able to afford medicine. Not only is it a kind way to treat people, but it’s great for the bottom line.
A comprehensive benefits package can increase employee loyalty. In turn, you end up paying less in turnover costs. Furthermore, your employees are more willing to go above and beyond if you meet their needs.
How important are benefits? Surveys reveal that 79 percent of employees would rather have a new benefit than a raise.
Which benefit is the most important? It’s health insurance by a long shot.
If your employees can’t afford the medicine they need to have , it’s a pretty good bet that they won’t like their benefits package. That’s where you can step in and help.
Ask Your Insurance Provider About the Restasis Cost
What happens when an employee is frustrated and comes to you for answers? You may not be able to ask what medications your staff takes, but they can volunteer this information. If they are frustrated enough with Restasis to bring it up with you, you need to figure out a solution before your employee leaves.
Before you jump on the phone and haggle with your insurance provider, make sure you know some basic terminology.
You will need to ask the insurance company about the prior authorization procedures. The employee can submit a form to the insurance provider that says why they need the medication. The insurance company then decides whether to cover Restasis.
Get your insurance provider on the phone. It may be difficult to get to the right person, but keep pushing.
If you have a representative that works with your business, start with that contact. Here are a few questions you will want to be answered:
- How can my employee get prior authorization for this medicine?
- What are the chances of receiving that authorization?
- If we get authorization, how much will Restasis cost per refill?
- What pharmacy can my employee use?
Write down all of the information you gather and pass it along to your employee. Make sure to keep yourself open to any questions they may have.
What If the Insurance Provider Won’t Authorize?
At a certain point, it may become clear that your company’s insurance provider isn’t going to play ball. For whatever reason, they may reject the prior authorization request.
You could pony up the money yourself in hopes that the valued employee won’t bail on you. If that’s not an option, explore other resources.
For example, eDrugSearch is a free online resource that you can encourage your employee to use. When you search for any drug on this site, you can find coupons and affordable prices. The search tool even shows the price per dose, so your employee can buy with confidence.
You can learn more about this site and help your employee get the eye care they deserve.
Help Your Employees and Your Business
If anyone on your staff suffers from chronic dry eye, you can help them feel better. First, remember that helping your employee like this can help your business too. Then, try to get your insurance provider to help with the Restasis cost.
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