VYZULTA (latanoprostene bunod)
SELF ADMINISTRATION
Indications for Prior Authorization:
- Indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension
Patients must meet the following criteria for the indication(s) above:
- Patients are 17 years of age or older, AND
- Diagnosis of open-angle glaucoma or ocular hypertension, AND
- Tried and failed generic Latanoprost, AND
- Tried and failed one of the following:
- Ophthalmic beta-blockers (e.g. Timolol), OR
- Ophthalmic alpha-2 adrenergic agonist (e.g. Brimonidine), AND
- Does not exceed 5 mL per 30 days
Dosing:
- One drop in the affected eye(s) once daily in the evening
Approval:
- 1 year
Last review date: July 30, 2020