OZURDEX (dexamethasone intravitreal implant)

OZURDEX (dexamethasone intravitreal implant)

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