Paying for CEQUA

2 ways to save with CEQUA

With CEQUA, you make the call on what works best for you.

Cequa Support Pharmacy offers free home delivery and is the lowest cost option for people with commercial insurance.* They can also send texts directly to your phone confirming prior-authorization information, reminding you of refills, and alerting you that your prescription is on its way.

1-month supply

Delivery box and savings offer of paying as low as $10 a month for a 1-month supply of CEQUA with Cequa Support™ Pharmacy.

Pay as low as

$5

a month

$90 maximum out-of-pocket and free home delivery in 3-5 days or sooner§

Choose Cequa Support™

If you prefer going to your local pharmacy, you may be eligible to save on your prescription costs by activating a copay card. Be sure to have your copay card available when you pick up your prescription.

1-month supply

Small copay card with savings offer of paying $10 a month for a 1-month supply of CEQUA if you get CEQUA at a retail pharmacy.

Pay as low as

$10

a month

No maximum guarantee on out-of-pocket costs, and delivery fees may apply§

CHOOSE RETAIL PHARMACY

While the list price of CEQUA is $507, most people will not be responsible for paying the full amount. Certain factors like
personal insurance and/or deductibles may impact the price of your CEQUA prescription. Whatever your coverage may be, there
are options available to help you find the best pricing.

Outline of a delivery truck to show that your prescription will be sent to your home for free when you use Cequa Support™ Pharmacy.

Cequa Support

With Cequa Support, you’ll receive FREE delivery to your home in 3 to 5 business days after your approval. You do not need a copay card to receive this savings.

1-Month Supply

Pay as
little as

$5

And no more than $90

OR

3-Month Supply

Pay as
little as

$10

And no more than $180

Cequa Support Pharmacy will call you from 1-833-442-3782 to confirm
your insurance information within 24 hours.

Please return their call if you miss it. You can reach them directly at the number above, Monday
through Friday, 8 AM - 8 PM ET.

Retail Pharmacy Savings

You can get CEQUA at your local retail pharmacy and save on your
prescription with a copay card. However, CEQUA is available at a lower
cost if you have it delivered through Cequa Support Pharmacy.

1

Click here to activate, download, or
print the copay card.

2

Bring or show the copay card to your local
pharmacist to receive the discount.

Close-up of a woman’s hand zippering her wallet.

Are you on Medicare
or Medicaid?

You can receive CEQUA through your local pharmacy, though the cost of CEQUA will depend on your personal coverage. Please note that CEQUA Support Pharmacy is available only for commercially insured patients.

If you’re thinking about starting a chronic dry eye treatment,
consider one with minimal side effects.

CEQUA side effects

*Eligibility rules apply. Not valid for patients paying cash or with government insurance including, but not limited to, Medicare or Medicaid. Patients must reside in the United States, Puerto Rico, Guam, or the Virgin Islands.

Commercially insured patients may pay as little as $10 per month. The program covers out-of-pocket costs up to $250 per prescription.

Copay costs are determined by the health plan’s formulary status for CEQUA, as well as a patient’s insurance benefit (ie, deductibles, out-of-pocket maximums).

§Eligibility rules apply. Not valid for patients with government insurance including, but not limited to, Medicare or Medicaid. Actual out-of-pocket costs for CEQUA will vary according to the patient’s commercial coverage. Maximum benefit is $250 per fill or $3,500 per year (up to 14 fills). Patients must be aged 18 years and older and reside in the United States, Puerto Rico, Guam, or the Virgin Islands.

Important Safety Information

WHAT IS CEQUA?

CEQUA™ (cyclosporine ophthalmic solution) 0.09% is a topical solution that helps to increase the production of natural tears in your eye. Dry eye disease may affect the ability of your eyes to produce its own tears.

IMPORTANT SAFETY INFORMATION

Do not use CEQUA if you are allergic to any of its ingredients. Be careful not to allow the vial tip to touch your eye or any surfaces, to help avoid potential eye injury or contamination of the product.

CEQUA should not be used while wearing contact lenses. If contact lenses are worn, they should be removed prior to using CEQUA and may be reinserted after 15 minutes.

Put one drop of CEQUA twice daily (approximately 12 hours apart) into each eye using a single-use vial. The solution should be used immediately after opening, and discard the vial and remaining contents immediately after using.

The most common side effects that may be experienced while using CEQUA include: eye pain after administering drops and eye redness. Other side effects reported were eye irritation, eyelid inflammation, headache, and urinary tract infection.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see the Full Prescribing Information.