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Luminopia is Now Covered by Anthem for Qualifying Patients
Our FDA-cleared lazy eye (amblyopia) treatment — which allows children to watch TV to improve their vision instead of wearing an eye-patch — is now more affordable for your family.
Ask your child's eye doctor if Luminopia is right for them. If your doctor is unfamiliar with prescribing Luminopia, they can visit the Healthcare Professional tab on our website for additional information.
If you are looking for a provider near you already familiar with Luminopia:
Share your Anthem insurance information with your doctor so they can include it on the Luminopia prescription. This allows our partner, CoAssist Pharmacy, to verify your coverage quickly to determine if you meet Anthem’s eligibility criteria.
Main eligibility criteria include:
Age Range: Your child must be 4 to 13* years old.
Diagnosis: Your child must have Amblyopia (commonly called "Lazy Eye"), where their vision in one eye is significantly worse than their other eye even when your child is wearing their glasses.
Previous Treatment: Your child needs to have already tried eye patching or Atropine drops for at least 6 months prior
CoAssist will reach out to you directly if your insurance information is missing from your prescription, so nothing slows down your child's access to treatment.
If your medical benefits indicate Anthem coverage, Pentec Health will work with your doctor to secure Anthem coverage and reach out to you by secure text message throughout the process to keep you updated. Once your prescription is with Pentec, you are welcome to contact them to discuss your coverage status at 866-751-1077.
Luminopia is covered by Anthem as a medical benefit. That means for eligible Anthem members your insurance will help pay for it— but you might still need to pay part of the cost. How much you pay depends on your insurance plan.
Here is a simple explanation of how it works.
Insurance plans have a few rules about who pays what. These four words are important to understand:
Key Terms
What It Means (in plain English)
Deductible
The amount you pay out of pocket before insurance starts contributing
Copay
A flat fee you pay each time.
Coinsurance
You and your insurance split the cost. If your share is 20%, you pay 20% and your insurance pays 80%
Out-of-Pocket Maximum
The most you will ever pay in one plan year. Once you hit this limit, your insurance pays 100% for the rest of the year.
Your cost depends on where you are in your insurance year. Here are the three situations you might be in:
Your Situation
What You’ll Pay
📋 Haven’t met your deductible yet
You pay the full cost yourself right now. But don’t worry — this money counts toward your deductible, so you’re getting closer to insurance helping.
✅ Met your deductible, but not your max
Your insurance starts helping! You pay your share — either a flat copay (like $50) or a percentage (like 20%). Your insurance covers the rest.
🎉 Met your out-of-pocket maximum
Great news — your insurance pays 100%! You pay nothing for covered services for the rest of the plan year.
Note: Cost-sharing varies by plan. Some plans use copays (a flat fee), others use coinsurance (a percentage). Check your insurance card or call the number on the back if you’re unsure.
If you haven't received a text from CoAssist confirming your prescription—or a request for additional information—within 3 business days, you can contact CoAssist directly to check on your prescription status at (855) 382-2533.
We've got you covered, whether you have Anthem or not. We're committed to ensuring every patient prescribed Luminopia can access therapy. If you’re concerned about cost, Luminopia access programs may be able to help.
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