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


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


  • Elevation in intraocular pressure


Last review date: July 21, 2016

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