RHOPRESSA (netarsudil solution)

RHOPRESSA (netarsudil solution)

SELF ADMINISTRATION- OPHTHALMIC

Indication for Prior Authorization:

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

Coverage Criteria:

• Patient is 18 years of age or older, AND
• Diagnosis of open-angle glaucoma or ocular hypertension, AND
• Failure of one prostaglandin (e.g. latanoprost), AND
• Failure of one of the following:
  • Ophthalmic beta blocker
  • Alpha-2 adrenergic agonist
  • Carbonic anhydrase inhibitor, AND
• Does not exceed a quantity of 5 mL per 30 days

Dosing:

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

Coverage Duration:

• Initial: 1 year
• Reauthorization: 1 year

Authorization is Not Covered for the Following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.

Additional Information:

• Pregnancy: There are no available data on Rhopressa use in pregnant women to inform any drug associated risk; however, systemic exposure to netarsudil from ocular administration is low
• Lactation: There are no data on the presence of Rhopressa in human milk, the effects on the breastfed infant, or the effects on milk production. However, systemic exposure to netarsudil following topical ocular administration is low, and it is not known whether measurable levels of netarsudil would be present in maternal milk following topical ocular administration
• Safety and effectiveness in pediatric patients below the age of 18 years have not been established
• Contact lenses should be removed prior to instillation of Rhopressa and may be reinserted 15
  minutes following its administration

Review History:

• 1/4/21- Annual review, format updated
• 6/26/19- Annual review, no changes
• 7/17/18- Original review

References: 

• Rhopressa [package insert]. Irvine (CA): Aerie Pharmaceuticals, Inc.; 2019.