cenegermin-bkbj — Blue Cross Blue Shield of Kansas

Initial criteria

• The patient has a diagnosis of neurotrophic keratitis (NK)
• The patient has stage 2 (persistent epithelial defect [PED]) or stage 3 (corneal ulcer) NK
• ONE of the following:
• A. The patient has NOT been previously treated with the requested agent in the affected eye(s) AND ALL of the following:
• 1. The patient’s PED and/or corneal ulcer have been present for at least 2 weeks
• 2. ONE of the following:
• A. The patient’s NK has been refractory to at least ONE conventional non-surgical treatment (i.e., preservative-free lubricant eye drops