Restasis MultiDose — Medical Mutual
Dry Eye Conditions due to Ocular Surface Diseases (e.g., ocular rosacea, atopic keratoconjunctivitis, acute corneal graft rejection, blepharitis, herpetic stromal keratitis, conjunctival graft versus host disease)
Initial criteria
- Patient is age ≥ 16 years
- Medication is prescribed by an ophthalmologist, optometrist, or rheumatologist
Approval duration
1 year initial, 1 year reauth