INVELTYS (loteprednol etabonate) 

SELF ADMINISTRATION - Ophthalmic

Indications for Prior Authorization:
  • Indicated for the treatment of post-operative inflammation and pain following ocular surgery
Patients must meet the following criteria for the indication(s) above:
  • Diagnosis of post-operative inflammatory pain confirmed by chart note documentation, AND
  • Must try and fail 2 generic alternatives such as dexamethasone sodium phosphate ophthalmic solution 0.1%, fluorometholone ophthalmic suspension 0.1%, prednisolone acetate ophthalmic suspension 1%, Lotemax® ophthalmic suspension 0.5%, Lotemax® ophthalmic ointment 0.5%, Lotemax® ophthalmic gel 0.5%
Dosing:
  • Instill one to two drops of Inveltys™ into the affected eye twice daily beginning the day after surgery and continuing throughout the first two weeks of the post-operative period
Approval: 
  • 14 days
  • Max 1 fill, 2 bottles

Last review date: May 21, 2019

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