Copay savings card
Source confirmed May 2026XIIDRA My Savings Program (Bausch + Lomb Access)
Bausch + Lomb · Xiidra
Patient pays: as little as $0 per prescription
commercial insurance
How to apply: online, phone, or text
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Free help paying for Xiidra.
Every Xiidra assistance program you may qualify for - manufacturer and foundation programs, not a discount card. About a minute, no login.
Xiidra help that still works on Medicare or Medicaid - the programs copay cards leave out.
Tell us five things. We’ll do the rest.
Xiidra (lifitegrast ophthalmic solution 5%) is a lfa-1 antagonist (topical ophthalmic) made by Bausch + Lomb. It is commonly prescribed for: Signs and symptoms of dry eye disease. Without financial assistance, Xiidra typically costs around $700 per month.
Income limits
Xiidra income limits in dollars (2026)
1 of the 2 active Xiidra assistance programs we track caps household income. The lowest cutoff is $47,880 a year for a single person. Most programs publish their cutoff as a percent of the federal poverty level - here is what that means in dollars.
Bausch + Lomb Patient Assistance Program - Xiidra
Household income at or below 300% of the federal poverty level:
| Household size | Annual income limit |
|---|---|
| 1 person | $47,880 |
| 2 people | $64,920 |
| 3 people | $81,960 |
| 4 people | $99,000 |
| Each additional person | + $17,040 |
Dollar amounts for percent-of-poverty caps are computed from the 2026 federal poverty guidelines for the 48 contiguous states and Washington, DC ($15,960 for one person, plus $5,680 for each additional household member). Alaska and Hawaii use higher figures. Each program makes the final eligibility decision - confirm on the official application linked above.
Not sure which kind of help you qualify for?
Xiidra offers more than one kind of program, and they have opposite rules:
- Have private insurance? The copay card can cut your monthly cost - but it can’t be used with Medicare, Medicaid, the VA, or Tricare.
- Uninsured or low-income? The patient assistance program may give you Xiidra free or nearly free, if your income is under its limit.
- On Medicare? The copay card won’t work, but Xiidra’s patient assistance program still does - plus federal Extra Help.
We show both programs, and the real income limits, below. Or read the full copay card vs patient assistance guide
All Xiidra programs we know about
This is the full list before we filter by your situation. Use the calculator above to see only the ones you may qualify for.
Manufacturer assistance
Source confirmed May 2026Bausch + Lomb Patient Assistance Program - Xiidra
Bausch + Lomb Patient Assistance Program · Xiidra
uninsured · underinsured · Medicare Part D
How to apply: online or phone
Your prescriber signs part of the form.
Xiidra assistance, answered plainly
Is there a Xiidra patient assistance program?
Yes. Bausch + Lomb Patient Assistance Program runs the Bausch + Lomb Patient Assistance Program - Xiidra, which provides Xiidra free of charge to eligible patients. Household income generally needs to be at or below 300% of the federal poverty level. The full rules and the official application link are in the program list above.
Does Medicare cover Xiidra?
Medicare coverage for Xiidra depends on your own plan: depending on how it is given, a drug can fall under Part B (administered in a clinic) or Part D (filled at a pharmacy), and each plan decides what it covers. Your plan's documents or Medicare's plan finder are the only reliable check. Separate from coverage, Bausch + Lomb Patient Assistance Program - Xiidra is open to some Medicare patients when out-of-pocket costs stay high - details above.
Is there a Xiidra copay card or coupon, and who can use it?
Yes - the XIIDRA My Savings Program (Bausch + Lomb Access) from Bausch + Lomb. Eligible patients pay as little as $0 per prescription. It works for patients with commercial (private) insurance. Patients on Medicare or Medicaid cannot use the card itself, but other Xiidra programs above do work with government insurance. If you searched for a Xiidra coupon, this manufacturer card is the official version of it.
How much does Xiidra cost without insurance?
Without insurance or assistance, Xiidra typically costs around $700 per month in the US. The Bausch + Lomb Patient Assistance Program - Xiidra above can bring that down substantially for eligible patients - use the calculator to check your situation.
Where do I find the Xiidra patient assistance application form?
The official application form for the Bausch + Lomb Patient Assistance Program - Xiidra is on patientassistance.bausch.com - the application links on this page go straight to the program's own form. Some programs call it an enrollment form; it is the same document. Applying is always free; never pay a third-party service to file a patient assistance form for you.
Does Xiidra assistance work if I am on Medicare or Medicaid?
Yes. Bausch + Lomb Patient Assistance Program - Xiidra is open to some patients on Medicare - each program's exact rules are listed above, and the calculator checks the income limits against your household.
Is the Xiidra patient support program the same thing as patient assistance?
Manufacturers like Bausch + Lomb use "patient support program" as an umbrella term for nurse lines, insurance navigation, and financial help. The financial help is what we track here - for Xiidra that is the Bausch + Lomb Patient Assistance Program - Xiidra. The support phone line is listed on the official program site linked above.