Dexamethasone intravitreal implant (Ozurdex)

OFFICE ADMINISTRATION - Sterile Environment / Aseptic Technique

Indications for Prior Authorization:

  • Macular edema following branch vein occlusion
  • Macular edema following central retinal vein occlusion
  • Non-infectious uveitis
  • Diabetic macular edema

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

  • Any other diagnosis not listed in the approved indications

Dosing:

  • Ozurdex implant 0.7 mg intravitreal implant x 1 every 6 months as needed

Monitoring:

  • Elevation in intraocular pressure

 

Last review date: July 21, 2016