lotilaner ophthalmic solution 0.25% — Blue Cross Blue Shield of Texas

Initial criteria

• Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG) AND BOTH of the following:
• The patient does NOT have any FDA labeled contraindications to the requested agent AND
• ONE of the following:
• The patient has another FDA labeled indication for the requested agent and route of administration OR
• The patient has another indication supported in compendia for the requested agent and route of administration OR
• The prescriber has submitted TWO articles from major peer-reviewed professional medical journals (e.g., JAMA, NEJM, Lancet) supporting the proposed use(s) as generally safe and effective (case studies not acceptable; journal articles required)

Approval duration

12 months