Combigan is expensive primarily because it’s a brand-name combination eye drop in a U.S. pharmaceutical market where glaucoma medications are consistently priced far higher than in other countries. A single bottle of brand-name Combigan costs around $207 at retail, adding up to roughly $1,564 per year. That’s more than four times what the same medication costs in Canada, where the annual price sits around $371.
What Combigan Is and Why It Costs More Than Single Drops
Combigan combines two active ingredients into one bottle: brimonidine tartrate (0.2%) and timolol maleate (0.5%). Brimonidine is an alpha-agonist that reduces the amount of fluid your eye produces while also helping it drain. Timolol is a beta-blocker that primarily slows fluid production. Together, they lower eye pressure through two separate pathways, which is why doctors prescribe Combigan when a single medication isn’t enough.
Combination drugs generally carry a price premium over their individual components. Timolol alone, as a generic, is one of the cheapest glaucoma drops available, with annual costs starting around $71. But packaging two drugs into a single sterile ophthalmic solution with precise concentrations and stability involves more complex manufacturing. Allergan (now part of AbbVie) has historically priced Combigan at the higher end of the glaucoma market, making it one of the most expensive glaucoma drops in studies comparing U.S. medication costs.
The Generic Exists, but Prices Vary Widely
Generic brimonidine/timolol first hit the U.S. market in April 2022. That should have been the end of the pricing problem, and for some people it was. With a discount coupon, the generic version can cost as little as $22, which is about 89% less than the average retail price of $191. But not everyone gets that price.
Your actual cost depends on whether your pharmacy stocks the generic, whether your insurance formulary covers it, and whether your plan applies the brand-name price to your copay. Brand-name Combigan still sits on Tier 3 of many insurance formularies, including major Medicare plans from UnitedHealthcare, which means higher copays than preferred generics on Tier 1 or 2. If your doctor writes a prescription for “Combigan” without specifying that a generic substitution is acceptable, or if your plan has restrictions, you may still end up paying the brand-name price.
U.S. Pricing vs. the Rest of the World
The price gap between the U.S. and other countries is striking. A study published in the Journal of Ophthalmology compared glaucoma medication costs at Costco pharmacies in both countries. Combigan cost $206.79 per bottle in the U.S. and $49.01 in Canada. Over a year, that’s a difference of nearly $1,200.
This wasn’t unique to Combigan. Every brand-name glaucoma drug in the study was more expensive in the U.S., ranging from about 2 to 7 times the Canadian price, with an average markup of 4.1 times. The U.S. lacks the government price negotiations that countries like Canada use to set drug costs, which is the single biggest structural reason American patients pay more for the same medications.
How the Cost Affects People Who Need It
Glaucoma eye drops aren’t optional. They prevent irreversible vision loss by keeping eye pressure under control, and skipping doses has real consequences. Yet national survey data shows that people with glaucoma are significantly more likely to report being unable to afford their medications than people without the condition (8.2% vs. 6.4%). Between 9% and 13% of glaucoma patients reported skipping doses, taking less medication, or delaying prescriptions specifically to save money. About 7% turned to alternative therapies as a cost-saving measure, raising concerns about whether they were still using their prescribed drops consistently.
This matters because glaucoma damage is permanent. Once nerve fibers in the eye are lost, vision doesn’t come back. A medication that works perfectly but costs too much for someone to use consistently is, in practice, a medication that doesn’t work.
Ways to Lower Your Cost
The most effective step is switching to generic brimonidine/timolol if you haven’t already. Ask your doctor or pharmacist to confirm the prescription allows generic substitution. Pharmacy discount programs like GoodRx can bring the generic price below $22, which is often cheaper than an insurance copay.
If you’re uninsured or underinsured and need the brand-name version, AbbVie runs a patient assistance program called myAbbVie Assist. Eligibility is determined case by case, but the program covers people who can’t afford their medication, including some Medicare Part D enrollees. You’ll need to provide your Social Security number and proof of U.S. residency.
Another option worth discussing with your eye doctor: using the two ingredients as separate generic drops. Generic brimonidine and generic timolol are both inexpensive on their own. The tradeoff is using two bottles instead of one and dealing with two dosing schedules, but the combined cost is often lower than even the discounted generic Combigan price. For some patients, the inconvenience is worth the savings.