XIIDRA (lifitegrast) 

SELF-ADMINISTRATION

FDA Approved Indication:
  • Treatment of the signs and symptoms of dry eye disease (DED)
Prior authorization criteria:
  • Patient has been diagnosed with dry eye disease, AND
  • Patient is at least 17 years of age, AND
  • Patient has tried and failed both artificial tears and Restasis, supported by chart note documentation
Dosing:
  • One drop twice daily in each eye (approximately 12 hours apart)
Approval:
  • One year

Last review date: August 21, 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