Find Xiidra formulary coverage for your area
Use the field below to look up your patient’s formulary coverage for Xiidra.
COVERAGE IINFO:
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Check health plan coverage and patient costs, as they may vary or change without notice.
*Based on number of lives covered.
†Covered at any tier; additional restrictions may apply for certain plans.
For informational purposes only. Not all payers or plans may be included.
Formulary Coverage Key1
Tier 1: These drugs are available at the lowest co-pay. Most commonly, these are generic drugs.
Tier 2: These drugs are available at a middle-level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
Tier 3: These drugs are available at a higher-level co-pay. Most commonly, these are "non-preferred" brand drugs.
Tier 4: These drugs are available at a higher-level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
Tier >4: These drugs are available at a higher-level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
ST: Step Therapy. This restriction typically requires that certain criteria be met prior to approval for the prescription.
QL: Quantity Limit. Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of drug that will be covered.
N/A: Not Available. Formulary data for this drug/health plan are not available.
NC: Not Covered. Drugs that are not covered by the plan.
OR: Other Restrictions. Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
PA: Prior Authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Reference
- Centers for Medicare & Medicaid Services. How Medicare Prescription Drug Plans & Medicare Advantage Plans with Prescription Drug Coverage (MA-PDs) Use Pharmacies, Formularies, & Common Coverage Rules. October 2015.
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Check health plan coverage and patient costs, as they may vary or change without notice.
For informational purposes only.