Miebo is perfluorohexyloctane ophthalmic solution, a Bausch + Lomb eye drop for dry eye disease that works differently from everything that came before it. The prescribing information describes it as a semifluorinated alkane that forms a monolayer at the surface of the tear film, and the two pivotal trials behind it, GOBI and MOJAVE, enrolled patients with dry eye disease and clinical signs of meibomian gland dysfunction. It contains no water and no preservative, just 100% perfluorohexyloctane.
Being genuinely new is expensive. There is no generic, no therapeutic equivalent, and no older molecule to substitute. What Miebo does have is something most brand-name drugs do not: a published fixed cash price for uninsured patients, straight from the manufacturer, that is roughly a quarter of the retail price. Everything below was researched September 3, 2026.
What Does Miebo Cost Without Insurance?
The standard package is a 3 mL multiple-dose bottle, which the prescribing information states explicitly. Bausch + Lomb also lists a 1.6 mL package in the FDA drug directory.
CMS’s National Average Drug Acquisition Cost survey, which measures what pharmacies pay wholesalers rather than what patients pay, priced Miebo at $263.60747 per mL effective August 19, 2026, essentially flat against $263.64339 on the July 22 vintage. At 3 mL that is $790.82 per bottle in pharmacy acquisition cost. Drugs.com quotes $270.49 per mL, which is $811.47 for the same 3 mL. SingleCare lists an average retail price of $1,234.30 per 3 mL bottle with a discount-card price of $809.73.
And Bausch + Lomb’s own savings card terms state that patients without health insurance may pay a fixed cash price of $225 per prescription.
| Miebo (perfluorohexyloctane) cost item | Low | Typical | High |
|---|---|---|---|
| One fill, manufacturer cash price for uninsured patients | $225.00 | $225.00 | $225.00 |
| 3 mL bottle, retail | $790.82 | $811.47 | $1,234.30 |
| Per mL, pharmacy acquisition cost (CMS NADAC) | $263.61 | $263.61 | $263.61 |
| Average Medicare Part D gross spending per claim, 2024 | $862.52 | $862.52 | $862.52 |
| Tyrvaya carton (2 bottles, 8.4 mL total), retail | $668.64 | $690.78 | $690.78 |
| Commercial insurance with copay card | $0 | $0 | $0 |
One caution on the retail figures. Drugs.com states its price for a “5 milliliters” quantity, which does not match either of the two package sizes Bausch + Lomb has listed with the FDA. The per-milliliter figure is what carries across, and at $270.49 per mL it is within 3% of the CMS acquisition cost, so the two sources agree closely on the unit price even though they describe different fill quantities.
CMS’s Part D spending data is the other useful cross-check. Average gross spending per Miebo claim was $862.52 in 2024 across 48,590 beneficiaries and $116.3 million in total spending, at $246.59 per dosage unit. That per-mL figure is within 7% of NADAC. It is also worth noting how fast that grew: in 2023 the same dataset shows just 6,324 Miebo beneficiaries and $9.3 million in spending, so this is a drug in the steep part of its launch curve.
What Drives the Price
No generic and no substitute. Perfluorohexyloctane is a single-source molecule under NDA 216675 with a May 2023 marketing start. Unlike cyclosporine eye drops, where eight or more generic makers have collapsed the acquisition cost, there is nothing here to substitute. The brand sets the price and will for years.
The four-times-daily schedule. The label directs one drop in each eye four times daily, which is double the dosing frequency of the twice-daily cyclosporine and lifitegrast drops. That is a bottle-consumption question rather than a per-milliliter price question, but it means the real monthly cost depends on how many milliliters your prescription is written for. Ask the pharmacy how many milliliters are in your fill before you compare quotes.
Insurance status, which the manufacturer prices explicitly. Bausch + Lomb’s terms split patients into three buckets: commercially insured, commercially insured but not covered for this drug, and no insurance at all. Each gets a different price, and only the third gets the $225 figure.
Age. The Miebo card terms state it is not valid for any person 65 or older without private or commercial insurance. An uninsured 66-year-old is excluded by the fine print.
Where you fill it. The gap between the CMS acquisition cost of $790.82 and SingleCare’s $1,234.30 average retail price for the same 3 mL bottle is more than $440 of pharmacy margin. That is a large spread for a single-source brand.
Cash Price vs. Insurance
For commercially insured patients, Bausch + Lomb offers a $0 copay card, and Miebo.com also routes prescriptions through BlinkRx, which applies available savings automatically without a separate card. If the plan covers the drug and your deductible is met, the out-of-pocket target is $0. If you have a high-deductible or coinsurance plan, the terms say plainly that you may pay more than $0.
If you have commercial insurance but the plan does not cover Miebo, or it is blocked by prior authorization, a step edit or an NDC block that has not been cleared, the same card still applies under Other Coverage Code 03 for up to 12 fills per calendar year, no more than once every 24 days.
If you have no insurance at all, the terms give you a fixed cash price of $225 per prescription under Other Coverage Code 01. Against the $791 to $1,234 retail band, that is a discount of 72% to 82%, and it is larger than what any pharmacy discount card delivers on this drug. SingleCare’s card price of $809.73, for comparison, is barely below the plain cash price.
If you are on Medicare, Medicaid, TRICARE or VA coverage, none of it applies. The card is void for federal and state program beneficiaries, and the practical question becomes your plan’s formulary tier. Uninsured patients over 65 are in the same position and should go to the Bausch + Lomb Patient Assistance Program, which supplies medication at no cost to people who meet its income criteria.
Miebo vs. Tyrvaya
Tyrvaya, varenicline nasal spray from Viatris, is the other recent branded dry-eye product patients tend to price against Miebo. It is not an eye drop at all, it is a nasal spray, and it sells as a carton of two 4.2 mL pump bottles.
On price the two are closer than you might expect. CMS priced the 8.4 mL Tyrvaya carton at $79.59960 per mL effective August 19, 2026, which is $668.64 for the carton, and Drugs.com quotes $690.78. Average Medicare Part D gross spending was $792.97 per Tyrvaya claim in 2024 across 28,409 beneficiaries.
The difference for a self-pay patient is what happens when you have no insurance. Bausch + Lomb publishes a $225 cash price for Miebo. Viatris publishes no equivalent cash price for Tyrvaya, and instead directs uninsured patients to the Viatris Patient Assistance Program, which can supply the drug free of charge to patients who meet financial and medical criteria. That is potentially better than $225 if you qualify and worse than $225 if you do not, and it takes an application either way.
How to Pay Less
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Ask for the manufacturer cash price by name, not for a coupon. The $225 figure is processed through the Bausch + Lomb savings card at the pharmacy counter using Other Coverage Code 01. Pharmacy staff will not offer it unprompted. Enroll before you drop the prescription off.
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Confirm your fill quantity in milliliters. Because Miebo is priced per milliliter and dispensed quantities vary, two “one month” quotes can differ by hundreds of dollars. Get the number of milliliters and the total price in the same sentence.
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Do not assume a discount card helps. SingleCare’s Miebo price sits near $810 against a $791 acquisition cost. Our comparison of GoodRx vs. SingleCare explains when these cards win, and single-source brands with a manufacturer cash program are usually not one of those times.
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If the card excludes you, apply for patient assistance early. The Bausch + Lomb Patient Assistance Program is the route for uninsured patients over 65 and for people on government coverage. It is income-tested and takes time, so start before you run out.
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Price the alternatives before you settle. Xiidra has an identical $225 uninsured cash price from the same manufacturer, and generic cyclosporine 0.05% costs a fraction of any of these. Which drug is right for you is a clinical decision, but the price differences are large enough to be worth raising with your prescriber.
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Budget the exam separately. A self-pay eye exam has its own cash range, and a free or sliding-scale clinic may be able to handle recheck visits once you are established. Our fair price checker is useful for sanity-checking the visit portion.
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If a pharmacy or clinic bill has already gone sideways, dispute it. Our guide to negotiating medical bills covers the script, and hospital price transparency applies if a health system pharmacy is doing the billing.
Bottom Line
An uninsured patient should be paying $225 per Miebo fill as of September 2026. That is Bausch + Lomb’s own published cash price, it comes from the manufacturer’s savings program rather than a third-party coupon, and nothing else on the market gets close.
Retail without that program runs $791 to $1,234 for the standard 3 mL bottle, and discount cards only bring it to roughly $810. The two situations that lock you out are enrollment in Medicare or another government program and being 65 or older without commercial insurance, both of which route you to the Bausch + Lomb Patient Assistance Program instead. With no generic perfluorohexyloctane in sight, those are the only levers there are.