Verkazia — Blue Cross Blue Shield of Alabama

Initial criteria

• - Diagnosis of vernal keratoconjunctivitis (VKC) AND BOTH of the following:
• - ONE of the following regarding mast cell stabilizer and antihistamine use: • Tried and had an inadequate response to combination of a topical ophthalmic mast cell stabilizer AND an antihistamine used in the treatment of VKC • Intolerance or hypersensitivity to combination of a topical ophthalmic mast cell stabilizer AND an antihistamine used in the treatment of VKC • FDA labeled contraindication to ALL topical ophthalmic mast cell stabilizers AND antihistamines AND
• - ONE of the following regarding corticosteroid use: • Tried and had an inadequate response to a topical ophthalmic corticosteroid used in the treatment of VKC • Intolerance or hypersensitivity to topical ophthalmic corticosteroid therapy