Ophthalmic NSAIDs
Indications for Prior Authorization
BROMSITE (bromfenac)
-
For diagnosis of Postoperative Inflammation and Prevention of Ocular Pain
Indicated for the treatment of postoperative inflammation and prevention of ocular pain in patients undergoing cataract surgery.
ILEVRO (nepafenac)
-
For diagnosis of Postoperative inflammation
Indicated for the treatment of pain and inflammation associated with cataract surgery.
NEVANAC (nepafenac)
-
For diagnosis of Postoperative inflammation
Indicated for the treatment of pain and inflammation associated with cataract surgery.
Prolensa (bromfenac ophthalmic solution)
-
For diagnosis of Postoperative inflammation
Indicated for the treatment of postoperative inflammation and reduction of ocular pain in patients who have undergone cataract surgery.
Criteria
Ilevro, Nevanac
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Step Therapy
Length of Approval: 12 Month(s)
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- One of the following:
- Patient is greater than 10 but less than 18 years of age [A] OR
- Trial and failure (of a minimum 30-day supply), contraindication, or intolerance to one of the following generics:
- Diclofenac ophthalmic solution
- Flurbiprofen ophthalmic solution
- Ketorolac ophthalmic solution
Brand Bromsite, Brand Prolensa, Generic bromfenac ophthalmic solution 0.075%, Generic bromfenac ophthalmic solution 0.07%
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Step Therapy
Length of Approval: 12 Month(s)
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- Trial and failure (of a minimum 30-day supply), contraindication, or intolerance to one of the following generics:
- Diclofenac ophthalmic solution
- Flurbiprofen ophthalmic solution
- Ketorolac ophthalmic solution
P & T Revisions
1970-01-01, 2025-12-18, 2025-09-05, 2024-10-30, 2024-09-02, 2024-03-27, 2024-03-06, 2023-11-01, 2022-10-06, 2021-09-22, 2021-05-21, 2020-09-09, 2019-10-02
References
- Bromsite Prescribing Information. Sun Pharmaceutical Industries, Inc.; Cranbury, NJ. April 2023.
- Ilevro Prescribing Information. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936. April 2023.
- Nevanac Prescribing Information. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936. April 2023.
- Bromfenac Opthalmic Solution 0.075% Prescribing Information. Sun Pharmaceutical Industries, Inc.; Cranbury, NJ. February 2024.
End Notes
- Pediatric patients age greater than 10 but less than 18 years of age are allowed to bypass the trial and failure requirement because Ilevro and Nevanac are approved for this pediatric population, but not Bromsite. The safety and efficacy in pediatric patients below the age of 18 years have not been established for Bromsite. [1, 2, 3]
Revision History
- 1970-01-01: No criteria change, bulk copy oRX-EHB
- 2025-12-18: no criteria changes, added IL statute operational note
- 2025-09-05: 2025 Annual Review. No criteria changes. Background updates.
- 2024-10-30: update guideline
- 2024-09-02: 2024 Annual Review. Updated references. Background updates.
- 2024-03-27: update guideline
- 2024-03-06: Added generic bromfenac as target to guideline.
- 2023-11-01: Annual Review, no changes.
- 2022-10-06: 2022 UM Annual Review.
- 2021-09-22: 2021 UM Annual Review.
- 2021-05-21: Addition of EHB formulary to guideline, no changes to criteria
- 2020-09-09: 2020 UM Annual Review.
- 2019-10-02: 2019 Annual Review. SL 10.02.19
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