Vyzulta — Medica

Preferred products

• generic bimatoprost 0.03% ophthalmic solution
• generic latanoprost 0.005% ophthalmic solution
• generic travoprost 0.004% ophthalmic solution

Initial criteria

• Patient has tried one Step 1 Product (generic bimatoprost 0.03% ophthalmic solution, generic latanoprost 0.005% ophthalmic solution, or generic travoprost 0.004% ophthalmic solution).
• OR Patient has a known benzalkonium chloride (BAK) sensitivity AND a known sensitivity to other ophthalmic preservatives (then approve Iyuzeh, Xelpros, or Zioptan).

Approval duration

1 year