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Xdemvy (lotilaner ophthalmic solution)Point32Health

Demodex blepharitis

Initial criteria

  • Documented diagnosis of Demodex blepharitis as determined by ALL of the following:
  • • Presence of at least mild erythema of the upper eyelid margin
  • • Presence of mites upon examination of eyelashes OR presence of collarettes on more than 10 lashes
  • AND Patient age ≥ 18 years
  • AND Prescribed by an optometrist or ophthalmologist

Reauthorization criteria

  • Initial criteria are met
  • AND The most recent treatment with Xdemvy was started no sooner than 6 months ago

Approval duration

6 weeks (initial); 6 weeks (reauth); no more than one course per 6 months