Travatan® Z (travoprost 0.004% ophthalmic solution [benzalkonium chloride-free] − Sandoz, generic) — Cigna
Open-Angle Glaucoma (including normal-tension glaucoma, also referred to as low-tension glaucoma or normal-pressure glaucoma)
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