Ophthalmic Antihistamines
Indications for Prior Authorization
LASTACAFT (alcaftadine)
-
For diagnosis of Allergic Conjunctivitis
Indicated for the prevention of itching associated with allergic conjunctivitis.
ZERVIATE (cetirizine)
-
For diagnosis of Allergic Conjunctivitis
Indicated for the treatment of ocular itching associated with allergic conjunctivitis.
Criteria
Lastacaft, Zerviate
Step Therapy
Length of Approval: 12 Month(s)
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- Trial and failure (of a minimum 30-day supply), contraindication, or intolerance to both of the following generics or preferred brands:
- azelastine
- olopatadine
P & T Revisions
2024-09-02, 2023-11-01, 2022-11-02, 2021-11-30, 2021-09-22, 2021-05-20, 2020-12-29, 2020-09-09, 2019-10-02
References
- Lastacaft Prescribing Information. Allergan, Inc, Irvine, CA. June 2020.
- Zerviate Prescribing Information. Eyevance Pharmaceuticals, Lakewood, NJ. October 2023.
Revision History
- 2024-09-02: 2024 Annual Review. Added in minimum trial duration.
- 2023-11-01: Annual Review, no changes.
- 2022-11-02: 2022 Annual Review
- 2021-11-30: update ST to remove Bepreve as a target drug.
- 2021-09-22: 2021 UM annual review.
- 2021-05-20: EHB specific guideline, added to EHB formulary, removed from ORx standard formulary. no changes to criteria
- 2020-12-29: Update ST to add Zerviate as target drug and remove Pataday as a trial and failure option.
- 2020-09-09: 2020 UM Annual Review.
- 2019-10-02: 2019 Annual Review. SL 10.02.2019
HEALTHY LIVING