Tips For Insurance & Cost Management For Dry Eye Disease

When you've been diagnosed with chronic dry eye disease, it's normal to feel overwhelmed. For starters, there are so many possible reasons behind dry eye, and it can take time to find the root cause. There are also myriad treatment options, which you'll likely need to use long term.

Needless to say, managing the costs associated with dry eye can be challenging. But there's some good news: With the right approach, it's possible to reduce out-of-pocket expenses, potentially making treatment more affordable.

Whether your health plan includes vision coverage or you have a separate vision plan, it's important to review your policy. This will help you identify which services and products are covered (and what isn't). 

If you're still confused after reviewing your policy, don't panic. This is understandable, given the medical jargon and fine print often used in insurance plans. 

Instead of staying in the dark, reach out to your insurance provider to clarify any doubts about coverage for dry eye treatment.

Get to know your insurance plan's formulary, also known as a drug list. A formulary is a list of prescription medications covered by your plan, according to the Health Insurance Marketplace.

Depending on the dry eye treatment, your insurance might need to approve prescription medication before covering it.

This is known as a prior authorization, and sometimes, your doctor may be able to request it, says Wong. 

If you have access to an FSA through your employer, use it to cover eligible eye care expenses with pretax dollars. This may include eye care services and medications, including dry eye treatments.

Many vision plans (or health insurance plans that include vision coverage) include free preventive services. For eye care specifically, the main service is a regular eye exam, which can help identify issues early and prevent more costly treatments later.

So, how often should you get regular eye exams? The exact frequency depends on your eye health, but in general, you'll want to see the eye doc every one or two years, according to the American Optometric Association. 

Before seeing an eye care provider, make sure they're in your insurance plan's network—i.e., a group of providers whose services your insurance will help pay for. Similarly, before filling a prescription at a pharmacy, make sure it's in network.

Be honest with your provider about your financial concerns. They can often recommend less expensive alternatives, such as over-the-counter or generic prescription medications.

Ask your eye doc for a complete treatment plan, including the expected costs and frequency of medications, potential alternatives, and any necessary tests or procedures.

To ensure you're using the most cost-effective options, regularly review your treatment plan and medication list with your doctor. 

"Some pharmaceutical companies partner with private pharmacies with an assistance program," explains Wong. This can help cover the cost of your medications.

"Additionally, some dry eye pharmaceutical companies have created their own medication distribution within private pharmacies," shares Wong. "It's a way to skip the 'middleman,' which is a cost savings for many patients."

These are programs that offer prescription discount cards or coupons, which can save you cash on medications. Typically, these programs require a monthly or annual membership fee, according to the Office of the New York State Attorney General, though some might be free.

If your doctor thinks you'll need long-term dry eye medication, it might be worth signing up for one of these programs.

You might be eligible to receive financial assistance or discounts from certain nonprofit organizations. 

If you live near an optometry college, check if they offer free eye exams. For example, the State University of NY College of Optometry offers free exams and medical tests every month—and there are no eligibility requirements. This can help you get a diagnosis for dry eye or get checked if your symptoms change.

When possible, choose over-the-counter or generic versions of medications, which are often cheaper than their brand-name counterparts.

Prices can vary widely between pharmacies, so always compare prices first. 

"Many dry eye treatments are long term since dry eyes are typically chronic and need continued maintenance," says Wong. Thus, it's important to find a medication that works for you.

If you have a prescription that you'll need to use regularly, buy in bulk when possible. Not only will this ensure you always have the treatment on hand, but you'll be able to save money too.