Alrex (brand and generic) — Cigna
allergic conjunctivitis
Preferred products
- generic azelastine hydrochloride 0.05% ophthalmic solution
- generic epinastine hydrochloride 0.05% ophthalmic solution
- prescription generic olopatadine 0.1% ophthalmic solution
- prescription generic olopatadine 0.2% ophthalmic solution
Initial criteria
- If the patient has tried one Step 1 Product, approve a Step 2 Product.
- If the patient requires the concurrent use of Alrex or generic loteprednol etabonate 0.2% ophthalmic suspension and an H1 antagonist or an H1 antagonist/mast cell stabilizer, approve Alrex or generic loteprednol etabonate 0.2% ophthalmic suspension.
- If the patient has tried a different ophthalmic steroid for the current condition, approve Alrex or generic loteprednol etabonate 0.2% ophthalmic suspension.
Approval duration
1 year