CEQUA (cyclosporine)

SELF-ADMINISTRATION - Ophthalmic

Indications for Prior Authorization:
  • Indicated to increase tear production in patients with keratoconjunctivitis sicca (dry eye)
All of the following must be met as a condition(s) for coverage:
  • Diagnosis of keratoconjunctivitis sicca (dry eye), AND
  • Trial and failure of artificial tears as confirmed by chart notes, AND
  • Trial and failure of both Restasis® and Xiidra®
Dosing:
  • Instill one drop of Cequa™ twice daily (approximately 12 hours apart) into each eye
Approval:
  • 1 year

 

Last review date: February 18, 2020

Rite Aid Pharmacy Patients: All Rite Aid pharmacies nationwide are closing! Please be on the lookout for information from Rite Aid pharmacies about their bankruptcy and store closures. Call your Rite Aid pharmacy for questions about your prescriptions and new pharmacy options. WHA is here to help as well. Contact Us via Phone