Miebo — Medical Mutual

Dry Eye Disease

Initial criteria

Patient is age ≥ 18 years; AND
Medication is prescribed by or in consultation with an ophthalmologist, optometrist, or rheumatologist; AND
Provider has administered testing for one of the following homeostasis markers with corresponding results: Schirmer’s test (< 5 mm of wetting over 5 minutes), OR Non-invasive tear breakup time (< 10 s), OR Osmolarity (≥ 308 mOsm/L in either eye or interocular difference of > 8 mOsm/L), OR Ocular surface staining (> 5 corneal spots, > 9 conjunctival spots, or lid margin [≥ 2 mm length and ≥ 25% width]); AND
If the diagnosis is mild dry eye disease, patient has tried and failed on preservative free artificial tears

Patient is age ≥ 18 years; AND
Medication is prescribed by or in consultation with an ophthalmologist, optometrist, or rheumatologist; AND
Patient has had a beneficial response to therapy, including reduced eye irritation, dryness, red eyes, or burning

1 year initial, 1 year reauth