Cystadrops (cysteamine ophthalmic solution) — Highmark
cystinosis
Initial criteria
- Diagnosis of cystinosis (ICD-10: E72.04)
- Medication is prescribed by or in consultation with an ophthalmologist
- Prescriber attests to the accumulation of corneal cystine crystals
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months