Pharmacy Prior Authorization Criteria

iDose TR (travoprost intracameral implant)

For diagnosis of Open-Angle Glaucoma
Indicated for the reduction of intraocular pressure (IOP) in patients with open-angle glaucoma (OAG).
For diagnosis of Ocular Hypertension
Indicated for the reduction of intraocular pressure (IOP) in patients with ocular hypertension (OHT).

*Can be taken as monotherapy or as concomitant therapy [C, D]

Prior Authorization

Length of Approval: Maximum of 1 time for each eye [A]

AND

AND

Trial and failure, contraindication or intolerance to three of the following prostaglandin analogs:

Trial and failure, contraindication or intolerance to two of the following prostaglandin analogs:

AND

Trial and failure, contraindication, or intolerance to one ophthalmic product from the following pharmacological classes:

Beta-adrenergic antagonist (e.g., timolol ophthalmic solution, levobunolol, etc.)
Alpha-adrenergic agonist (e.g., brimonidine ophthalmic solution, etc.)
Carbonic anhydrase inhibitor (e.g., dorzolamide ophthalmic solution, etc.)
Parasympathomimetic agent (e.g., pilocarpine ophthalmic solution, etc.)
Rho-kinase inhibitor (e.g., Rhopressa [netarsudil] ophthalmic solution, etc.)

AND

2024-02-12

iDose TR Prescribing Information. Glaukos Corp. San Clemente, CA. December 2023.
ClinicalTrials.gov. Randomized Study Comparing Two Models of a Travoprost Intraocular Implant to Timolol Maleate Ophthalmic Solution, 0.5%. Available at: https://www.clinicaltrials.gov/study/NCT03519386?cond=nct03519386&rank=1. Accessed January 24, 2024.
ClinicalTrials.gov. Clinical Study Comparing Two Models of a Travoprost Intraocular Implant. Available at: https://www.clinicaltrials.gov/study/NCT03868124?cond=nct03868124&rank=1. Accessed January 24, 2024.
UptoDate. Open-angle glaucoma: Treatment. Available at: https://www.uptodate.com/contents/open-angle-glaucoma-treatment?search=open%20angle%20glaocuma&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2. Accessed January 24, 2024.
Primary Open-Angle Glaucoma PPP 2020. American Academy of Ophthalmology. Available at: https://www.aao.org/preferred-practice-pattern/primary-open-angle-glaucoma-ppp. Published November 2020. Accessed January 24, 2024.

iDose TR should not be readministered to an eye that received a prior iDose TR. [1]
Prostaglandin analogs are the most frequently prescribed eye drops for lowering IOP in patients with glaucoma because they are most efficacious and well-tolerated, and they need to be instilled only once daily. Therefore, prostaglandin analogs are often selected as initial medical therapy unless other considerations, such as contraindications, side effects, intolerance, or patient refusal preclude their use. [5]
Sufficient treatment of glaucoma requires high level of adherence to therapy and multiple dosing requirements or side effects may impact a person’s adherence to therapy. If a single medication is effective in lowering IOP but the target pressure is not reached, combination therapy or switching to an alternative therapy may be appropriate. If despite good adherence to therapy the medication fails to reduce IOP, an alternative agent should be used [5]
If pharmacologic therapy is chosen, topical prostaglandins are sugessted as first-line pharmacologic therapy rather than other topical medications. Prostaglandins have lower rates of systemic side effects and may have somewhat better efficacy than beta blockers. Combining drops from different classes (ie, beta blocker plus prostaglandin or beta blocker plus carbonic anhydrase inhibitor) can cause a greater reduction in the IOP than monotherapy. Adding a second medication is reasonable if initial monotherapy is not effective. [4]