Verkazia (cyclosporine ophthalmic emulsion) — Highmark
moderate to severe vernal keratoconjunctivitis (VKC)
Preferred products
- generic ophthalmic antihistamines
- generic ophthalmic mast cell stabilizers
- generic ophthalmic corticosteroids
Initial criteria
- age ≥ 4 years
- diagnosis of moderate to severe VKC (ICD-10: H16.26)
- experienced therapeutic failure or intolerance to two of the following unique medication classes, or all are contraindicated: (1) generic ophthalmic antihistamines (e.g., olopatadine), (2) generic ophthalmic mast cell stabilizers (e.g., cromolyn sodium), (3) generic ophthalmic corticosteroids (e.g., dexamethasone, prednisolone, fluorometholone)
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months