Does Medicare cover Rhopressa (netarsudil ophthalmic drops)?
Medicare generally covers prescription drugs, but whether your specific plan covers Rhopressa depends on your Medicare drug benefit type (Part D) and the plan’s formulary (approved drug list). Coverage is not the same across all plans, and a drug can require prior authorization, step therapy, or a copay/coinsurance.
What to check in your plan (so you know if Rhopressa is covered)
To confirm coverage for Rhopressa under Medicare Part D, look up:
- The plan’s formulary entry for “Rhopressa” (netarsudil)
- Your cost-sharing (copay/coinsurance) for that specific drug
- Any restrictions, such as prior authorization or step therapy
- Whether the plan prefers a different netarsudil brand or a generic alternative (if available)
If you don’t have the formulary handy, you can usually find coverage details in your plan’s “drug lookup” tool or by calling the number on your Medicare Part D plan card.
If Rhopressa isn’t covered: common next steps
If your plan doesn’t cover Rhopressa or covers it only with restrictions, typical options include:
- Ask your prescriber to request prior authorization
- Ask about step-therapy requirements (trying another glaucoma medication first)
- Ask whether there’s a lower-cost alternative your plan covers
How Medicare Part B vs Part D matters
Rhopressa is a prescription eye drop, which is typically covered under Medicare Part D (not Part B). Part B is usually for things like certain clinician-administered drugs and specific outpatient services, but not most home-administered prescription drops.
Sources
No sources were provided in the prompt.