Xiidra

Indicated For

dry eye disease, dry eye inflammation

About This Medication

# Bausch + Lomb Patient Assistance Program Patient Guide: How to Get Xiidra (lifitegrast) at Low or No Cost Xiidra (lifitegrast ophthalmic solution) is a prescription eye drop used to treat the signs and symptoms of dry eye disease in adults. The **Bausch + Lomb Patient Assistance Program** (also referred to as Bausch Health PAP) helps eligible U.S. patients get **Xiidra** for free if they meet specific criteria like limited insurance coverage and financial need.[1][2] ## About Xiidra and Dry Eye Disease **Xiidra** is an eye drop that works by blocking a protein called lymphocyte function-associated antigen-1 (LFA-1), which reduces inflammation on the surface of the eye. It's typically used twice daily (one drop in each eye, about 12 hours apart). Common side effects include eye irritation, blurred vision, and a bad taste in the mouth. Always follow your doctor's instructions and report any serious side effects.[1] Dry eye disease affects millions of Americans, causing discomfort, burning, redness, and sensitivity to light. If you're struggling with the high cost of **Xiidra**—which can exceed $600 per month without insurance—this program can provide significant relief by shipping free medication directly to your home.[2] ## Who Qualifies for the Program? The program is designed for patients facing financial hardship with limited or no prescription coverage. Key eligibility requirements include: - Legal U.S. resident - Valid prescription for **Xiidra** from a licensed U.S. healthcare provider - Limited or no insurance coverage for the medication (including Medicare or Medicaid patients) - Treated as an outpatient - Meeting household income guidelines (reviewed case-by-case; specific Federal Poverty Level (FPL) thresholds not publicly detailed but focused on limited assets) - Medicaid patients may qualify even if coverage changes, especially post-October 2025 policy updates[1][2] Applications are reviewed individually, with no application fee. The program prioritizes those on government insurance or with no coverage.[1][2] ## Income Eligibility Breakdown Exact income thresholds (e.g., percentages of FPL) are not specified publicly and are evaluated case-by-case based on household size, assets, and other factors. The focus is on patients with **limited assets, limited or no prescription coverage, or government insurance**. Here's a general guide based on similar programs; confirm your status by applying: | Household Size | Estimated Income Limit (e.g., <400-500% FPL, case-by-case) | Notes | |---------------|-----------------------------------------------------------|-------| | Individual | Not specified; limited assets required | Prioritizes uninsured or underinsured | | Couple | Not specified; household income reviewed | Include all income sources | | Family of 3 | Not specified; case-by-case | Assets and coverage key factors | | Family of 4+ | Not specified; case-by-case | Larger families may have flexibility | Contact the program for a personalized assessment, as eligibility isn't strictly numeric.[1][2] ## Insurance Requirements You must have **limited or no prescription coverage** for **Xiidra**. This includes: - No private insurance coverage for the drug - Medicare Part D patients without coverage - Medicaid patients (special application available, especially if coverage lapsed after October 1, 2025)[1][2] Attach copies of your insurance cards (front and back). If you're on Medicaid, use the dedicated form. Patients with commercial insurance that doesn't cover **Xiidra** are also eligible.[1] ## Step-by-Step Application Process Applying is straightforward with multiple options. No cost to apply.[2] 1. **Check Eligibility**: Visit BauschHealthPAP.com or call (833) 862-8727 (Mon-Fri, 8am-8pm EST) to confirm **Xiidra** is covered and select the right form (Medicaid or non-Medicaid).[2] 2. **Download or Request Form**: Get the application online. Separate forms for Medicaid patients.[1][2] 3. **Complete Patient Sections**: Fill out personal info, insurance details, and sign authorizations (pages 2-3).[1] 4. **Prescriber Completes Their Part**: Your doctor fills pages 4-6, including prescription details and certification. Electronic signatures OK (not stamped for controlled substances).[1] 5. **Gather Documents**: Attach insurance cards (front/back). Pharmacy statements if requested.[1] 6. **Submit**: - **Phone**: Call (833) 862-8727 to apply over the phone.[2] - **Fax**: 844-705-0160[1] - **Mail**: Bausch Health Patient Assistance Program, P.O. Box 991624, Louisville, KY 40269[1] Missing info (marked with *) will hold your application.[1] ## Timeline and Delivery - **Review**: As fast as **24-48 hours**; you'll be notified of eligibility.[2] - **Approval**: If approved, medication ships free to your home—no copays or fees.[2] - **Duration**: Up to **1 year** of medication. Reapply annually if still eligible with a valid prescription.[2] Shipped directly to you for convenience.[2] ## Alternatives if Denied - **Reapply** with updated info or after circumstances change (e.g., loss of coverage).[2] - **Other Programs**: Check NeedyMeds.org, RxAssist.org, or Partnership for Prescription Assistance for **Xiidra** copay cards or state programs. - **Generic Alternatives**: No biosimilars for **Xiidra**; consider doctor discussion for other dry eye treatments like Restasis or over-the-counter drops. - **Appeal**: Contact the program at (833) 862-8727 for denial reasons and next steps.[2] ## Important Disclaimer This guide is for informational purposes only and based on publicly available program details as of the latest updates. Eligibility, terms, and availability can change—always verify directly with Bausch + Lomb at (833) 862-8727 or BauschHealthPAP.com. This is not medical advice; consult your healthcare provider about **Xiidra** suitability. The program reviews applications case-by-case, and approval is not guaranteed. Bausch + Lomb reserves the right to modify or end the program.[1][2]

Program information last verified: March 30, 2026