ROCKLATAN (netarsudil and latanoprost)

ROCKLATAN (netarsudil and latanoprost)

SELF ADMINISTRATION

Indications for Prior Authorization:

• Indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension

Patients must meet the following criteria for the indication(s) above:

• Patient is 18 years of age or older, AND
• Diagnosis of open-angle glaucoma or ocular hypertension as confirmed by chart note documentation, AND
• Patient has tried and failed Latanoprost AND one other agent from a different pharmacologic class (e.g. ophthalmic beta-blocker, ophthalmic alpha-2 adrenergic agonist, carbonic anhydrase inhibitors), AND
• Does not exceed a quantity of 2 bottles (5 mL) per month

Dosing:

• One drop into the affected eye(s) once daily

Approval:

• Initial: 1 year
• Renewal: 1 year if chart notes document a positive response to therapy