Vizz — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for the treatment of presbyopia in an adult patient
• The patient has NOT been receiving the requested drug for at least 14 days
• The presbyopia impacts the patient’s activities of daily living to the point where pharmacologic intervention is required (documentation required)

Reauthorization criteria

• The requested drug is being prescribed for the treatment of presbyopia in an adult patient
• The patient has been receiving the requested drug for at least 14 days
• The patient has demonstrated improvement from baseline presbyopia including gaining 3 lines or more in binocular distance corrected near visual acuity, without losing more than 1 line of corrected distance visual acuity (documentation required)

Approval duration

Initial therapy: 2 months; Continuation of therapy: 12 months