XIIDRA (lifitegrast)

XIIDRA (lifitegrast) 

SELF-ADMINISTRATION

FDA Approved Indication:

• Treatment of the signs and symptoms of dry eye disease (DED)

Prior authorization criteria:

• Patient has been diagnosed with dry eye disease, AND
• Patient is at least 17 years of age, AND
• Patient has tried and failed both artificial tears and Restasis, supported by chart note documentation

Dosing:

• One drop twice daily in each eye (approximately 12 hours apart)

Approval:

• One year