Restasis MultiDose — Medical Mutual
Dry Eye Conditions due to Systemic Inflammatory Disease (e.g., Sjogren’s Syndrome, rheumatoid arthritis, Systemic Lupus Erythematosus)
Initial criteria
- Patient is age ≥ 16 years
- Medication is prescribed by an ophthalmologist, optometrist, or rheumatologist
Approval duration
1 year initial, 1 year reauth