Restasis Multidose (cyclosporine 0.05% ophthalmic emulsion) — Cigna
Dry Eye Disease
Initial criteria
- Dry Eye Disease: Approve if patient age ≥ 16 years.
- Dry Eye Conditions due to Systemic Inflammatory Diseases: Approve if patient age ≥ 16 years.
- Dry Eye Conditions due to Ocular Surface Diseases: Approve if patient age ≥ 16 years.
Approval duration
1 year