Qlosi — Highmark
presbyopia
Initial criteria
- For Qlosi: age ≥ 45 years OR for Vuity: age ≥ 40 years
- Diagnosis of presbyopia (ICD-10: H52.4)
- Prescriber attests the member has experienced therapeutic failure to one of the following or all are contraindicated: eyeglasses OR contact lenses
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months