Orasis Pharmaceuticals is introducing two new options for eyecare providers (ECPs) to expand patient access to the prescription-based QLOSI (pilocarpine hydrochloride ophthalmic solution) 0.4%.
Let’s start with a little refresh on this drop.
The basics: FDA-approved in October 2023, QLOSI launched to the US market in April 2025 as a prescription, preservative-free (PF), low-dose pilocarpine solution with flexible dosing (more on that in a moment).
- What sets it apart: Its proprietary EyeQ Formulation, which holds pupil size at an optimal 2 to 3 mm to sharpen visual acuity (VA) via a "pinhole effect."
- The payoff: Greater depth of focus (and near vision) with less risk of diffraction.
- One more perk: This near-neutral pH drop pairs hyaluronic acid (HA) with hydroxypropylmethylcellulose (HPMC) for ocular comfort. Details here.
What’s its claim to fame?
QLOSI is the second-ever eye drop approved by the FDA indicated for the treatment of presbyopia among adults—and, as marketed: “the only FDA-approved eye drop with the lowest effective concentration of pilocarpine.”
What else should we know?
Since QLOSI’s launch, the FDA has received no reports of any retinal detachments or tears associated with drop use.
To note: A total of 45 reactions have been reported between 2025 and 2026, with the top few including visual impairment, blurred vision, photopsia, and headache.
- See here to view more via the FDA Adverse Event Monitoring System (AEMS) public dashboard.
And speaking of real-world use: Orasis also added that “real-world experience remains consistent with the efficacy, tolerability, and safety seen in QLOSI’s pivotal phase 3 trials.”
- Related: Check out those results for a better idea of its performance (and more recent safety data, reported earlier this year).
Now circle back to that flexible dosing component.
Per the prescribing information (PI), one drop goes in each eye for improved near vision.
- Efficacy: Onset within 20 minutes, lasting up to 8 hours after the second application.
Where the flexibility comes in: Redosing 2 to 3 hours after the first drop to extend the effect, capped at twice daily.
- For context: Higher-dose pilocarpine 1.25%—the first FDA-approved presbyopia drop—runs up to 9 hours on twice-daily dosing.
And the ideal patients for this?
Adults (largely aged 46 to 64) with early-to-moderate presbyopia plus mild myopia (-4.50 D to +2.00 D) or emmetropia as well as pseudophakic (post-cataract) and post-refractive patients.
- Who to skip: Those with peripheral retinal pathology, lattice degeneration, or high myopia.
Alrighty, I’m updated. Let’s talk about these two options.
While we previously reported on QLOSI’s accessibility for patients with (and without) insurance, Orasis is taking this two steps further by officially launching:
- A First Fill Free program
- Through BlinkRx (its pharmacy partner), patients receive a no-cost first-fill on their ECP’s prescription.
- Standard pricing follows thereafter.
- Through BlinkRx (its pharmacy partner), patients receive a no-cost first-fill on their ECP’s prescription.
- An in-office dispensing option
- Available in states where permitted (approximately 46 across the United States, but don’t quote us on that)
Dive more into each.
We’ll start with that in-office option first.
This, quite simply, enables ECPs to order QLOSI themselves and prescribe it in their own clinical practices. Check it out.
Next up: this free fist fill option.
One fact to keep in mind: QLOSI refill rates have already reportedly reached 49% in the 15 months since its U.S. debut (see here for how this compares to retail dry eye drop refill rates).
As for Orasis’s First Fill Free program, it requires ECPs to follow just three basic steps:
- Select a pharmacy, either in their electronic medical record (EMR) dropdown list or by sending scripts via phone or fax.
- Write a QLOSI prescription (see here for how and what patient information to include).
- Inform patients on next steps; the selected pharmacy will reach out to the patient to confirm their prescription as well as collect payment and shipping information.
To note: QLOSI ships free and is delivered directly to a patient's home, typically, within 5 to 7 days of an order. Auto-ship refills will also be directly delivered.
Noted. And, wasn’t there also a third option for patients looking for a trial run?
Yes! Eligible patients waiting for their first prescription to be filled / shipped, can have their ECPs order a QLOSI Starter Pack consisting of 10 single-use vials for the first 5 days of use.
A note to ECPs: Click here to download a guide on how to discuss patient expectations for QLOSI.