Netarsudil solution (Rhopressa®)

SELF ADMINISTRATION

Indications for Prior Authorization:

  • Indicated for the reduction of elevated intraocular pressure 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, 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

Approval:

  • 1 year

Last review date: June 26, 2019