Restasis — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for the treatment of dry eye disease.
• The request is for Cequa, Miebo, Restasis, Tryptyr, Tyrvaya, Vevye, or Xiidra.

Reauthorization criteria

• The requested drug is being prescribed for the treatment of dry eye disease.
• The request is for Cequa, Miebo, Restasis, Tryptyr, Tyrvaya, Vevye, or Xiidra.
• The patient achieved or maintained improvement in their signs and symptoms of dry eye disease from baseline (e.g., ocular irritation, redness, mucous discharge, reduced visual function, ocular surface damage, reduced tear production).

Approval duration

12 months