IDOSE TR (travoprost intracameral implant)

IDOSE TR (travoprost intracameral implant)

Office-Administration – intraocular implant

Diagnosis considered for coverage:

• Open-Angle Glaucoma: Indicated for the reduction of intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). 
• Ocular Hypertension: Indicated for the reduction of intraocular pressure (IOP) in patients with ocular hypertension (OHT).
   

Coverage Criteria:

For diagnosis of OAG or OHT:

• Diagnosis of open angle glaucoma (OAG) or ocular hypertension (OHT); AND
• Prescribed by an ophthalmologist; AND
• Patient has not previously received iDose TR in the intended eye; AND
• ONE of the following*: 
  • Trial and failure, contraindication or intolerance to three of the following prostaglandin analogs: 
    • generic bimatoprost 0.03% ophthalmic solution 
    • generic latanoprost 0.005% ophthalmic solution 
    • generic travoprost 0.004% ophthalmic solution 
    • generic tafluprost 0.0015% ophthalmic solution 
    • Lumigan (bimatoprost 0.01% ophthalmic solution), OR
  • BOTH of the following: 
    • Trial and failure, contraindication or intolerance to two of the following prostaglandin analogs: 
      • generic bimatoprost 0.03% ophthalmic solution 
      • generic latanoprost 0.005% ophthalmic solution 
      • generic travoprost 0.004% ophthalmic solution 
      • generic tafluprost 0.0015% ophthalmic solution 
      • Lumigan (bimatoprost 0.01% ophthalmic solution), and 
    • Trial and failure, contraindication, or intolerance to one ophthalmic product from the following pharmacological classes: 
      • Beta-adrenergic antagonist (e.g., timolol ophthalmic solution, levobunolol, etc.) 
      • Alpha-adrenergic agonist (e.g., brimonidine ophthalmic solution, etc.) 
      • Carbonic anhydrase inhibitor (e.g., dorzolamide ophthalmic solution, etc.) 
      • Parasympathomimetic agent (e.g., pilocarpine ophthalmic solution, etc.) 
      • Rho-kinase inhibitor (e.g., Rhopressa [netarsudil] ophthalmic solution, etc.) 

*Can be taken as monotherapy or as concomitant therapy
 

Coverage Duration:

• Maximum of 1 time for each eye

Dosing:

• iDose TR is a travoprost delivery system consisting of a travoprost releasing implant pre-loaded in a sterile, single-dose inserter.
• iDose TR is administered intracamerally through a small, clear corneal incision and is anchored into the sclera at the iridocorneal angle. 
• The intracameral administration should be carried out under standard aseptic conditions.
• iDose TR should not be readministered to an eye that received a prior iDose TR.

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.
 

Additional Information: 

• iDose TR should not be readministered to an eye that received a prior iDose TR.  
• Prostaglandin  analogs are the most frequently prescribed eye drops for lowering IOP in patients with glaucoma because they are most efficacious and well-tolerated, and they need to be instilled only once daily. Therefore, prostaglandin analogs are often selected as initial medical therapy unless other considerations, such as contraindications, side effects, intolerance, or patient refusal preclude their use. 
• Sufficient  treatment of glaucoma requires high level of adherence to therapy and multiple dosing requirements or side effects may impact a person’s adherence to therapy. If a single medication is effective in lowering IOP but the target pressure is not reached, combination therapy or switching to an alternative therapy may be appropriate. If despite good adherence to therapy the medication fails to reduce IOP, an alternative agent should be used.  
• If pharmacologic therapy is chosen, topical prostaglandins are suggested as first-line pharmacologic therapy rather than other topical medications. Prostaglandins have lower rates of systemic side effects and may have somewhat better efficacy than beta blockers. Combining drops from different classes (i.e., beta blocker plus prostaglandin or beta blocker plus carbonic anhydrase inhibitor) can cause a greater reduction in the IOP than monotherapy. Adding a second medication is reasonable if initial monotherapy is not effective. 
   

Policy Updates:

• 09/01/2024 – New policy for iDose approved by WHA P&T Committee. (P&T, 08/20/2024)

References:

1. iDose TR Prescribing Information. Glaukos Corp. San Clemente, CA. December 2023. 
2. ClinicalTrials.gov. Randomized Study Comparing Two Models of a Travoprost Intraocular Implant to Timolol Maleate Ophthalmic Solution, 0.5%. Available at: https://www.clinicaltrials.gov/study/NCT03519386?cond=nct03519386&rank=1. Accessed January 24, 2024. 
3. ClinicalTrials.gov. Clinical Study Comparing Two Models of a Travoprost Intraocular Implant. Available at: https://www.clinicaltrials.gov/study/NCT03868124?cond=nct03868124&rank=1. Accessed January 24, 2024. 
4. UptoDate. Open-angle glaucoma: Treatment. Available at: https://www.uptodate.com/contents/open-angle-glaucoma-treatment?search=open%20angle%20glaocuma&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2. Accessed January 24, 2024. 
5. Primary Open-Angle Glaucoma PPP 2020. American Academy of Ophthalmology. Available at: https://www.aao.org/preferred-practice-pattern/primary-open-angle-glaucoma-ppp. Published November 2020. Accessed January 24, 2024.