Lifitegrast (Xiidra)

SELF ADMINISTRATION

FDA Approved Indication:
  • Treatment of the signs and symptoms of dry eye disease (DED)
Prior authorization criteria:
  • Patient has been diagnosed with dry eye disease, AND
  • Patient is at least 17 years of age, AND
  • Patient has tried and failed both artificial tears and Restasis, supported by chart note documentation
Dosing:
  • One drop twice daily in each eye (approximately 12 hours apart)
Approval:
  • One year