Dry eye disease affects 30M Americans but most treatments are $500+/month brand-name drops

Chronic dry eye disease (DED) affects roughly 16 million diagnosed Americans (and an estimated 30M total), yet the two FDA-approved prescription treatments — Restasis (cyclosporine) and Xiidra (lifitegrast) — cost $500-600/month without insurance and $75-150/month with typical copays, and neither has a generic available despite Restasis going off-patent in 2024 after Allergan fought 13 separate patent challenges. Patients cycle through artificial tears ($15/month, temporary relief), warm compresses, and punctal plugs before reaching prescription therapy, wasting 6-18 months on inadequate treatment. The structural reason is that dry eye is classified as a chronic comfort condition rather than a sight-threatening disease, so insurers place DED drugs on specialty tiers with high cost-sharing. Meanwhile, ophthalmologists profit from in-office procedures (IPL, LipiFlow at $1,000-1,500/session) that have limited long-term efficacy data.