Oxervate (cenegermin-bkbj ophthalmic solution – Dompé) — Cigna

Initial criteria

• Patient has received < 8 weeks of treatment in the affected eye(s); AND
• The medication is prescribed by an ophthalmologist or optometrist

Reauthorization criteria

• Patient has received < 16 weeks of treatment per affected eye(s); AND
• The medication is prescribed by an ophthalmologist or optometrist

Approval duration

8 weeks per affected eye(s) per course (maximum total 16 weeks)