Travatan® Z (travoprost 0.004% ophthalmic solution [benzalkonium chloride-free] − Sandoz, generic) — Cigna

Initial criteria

• Patient age < 60 years (prior authorization required; age edit applies)
• FDA-approved indication OR other use with supportive evidence
• Prescription benefit coverage is not recommended for cosmetic conditions (e.g., eyelash growth)

Approval duration

1 year