Cysteamine ophthalmic (Cystaran®)

SELF ADMINISTRATION 

Indications for Prior Authorization:

  • Treatment of corneal cysteine crystal accumulation in patients with cystinosis

All of the following must be met as a condition for coverage:

  • Cystinosis: autosomal recessive inborn error in metabolism

This Medication is Not Approvable for the following condition(s):

  • Any condition not listed above as an approved indication

Dosing:

  • Instill one drop in each eye every waking hour

Approval:

Initial authorization: one year


 

Last review date: December 3, 2013