VEVYE (cyclosporine)

VEVYE (cyclosporine)

Self-Administration – Ophthalmic

Diagnosis considered for coverage:

• Indicated for the treatment of the signs and symptoms of dry eye disease

Coverage Criteria:

For diagnosis of dry eye disease:

• Diagnosis of dry eye disease; AND
• Trial and failure, contraindication, or intolerance to BOTH of the following:
  • Restasis (cyclosporine 0.05%) 
  • Xiidra (lifitegrast)

Reauthorization Criteria:

For diagnosis of dry eye disease:

• Patient demonstrates positive clinical response to therapy (e.g., increased tear production or improvement in dry eye symptoms)

Dosing:

Dry eye disease:

• Instill one drop of Vevye twice a day in each eye approximately 12 hours apart

Coverage Duration: 

• Initial: 1 year
• Reauthorization: 1 year

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information: 

• If used with other eye drops, a 15-minute interval between products should occur
• Clear, colorless, non-preserved ophthalmic solution containing cyclosporine 0.1% (1 mg/mL), delivering 0.01 mg of cyclosporine per one drop (0.01 mL)
• Safety and effectiveness in pediatric patients below the age of 18 years have not been established

Policy Updates:

• Effective 6/1/2024 – New policy approved by WHA P&T Committee. (P&T, 5/21/2024) 

References:

1. Vevye Prescribing Information. Alliance Medical Products, Inc. Irvine, CA. May 2023. 
2. American Academy of Ophthalmology. Dry Eye Syndrome Preferred Practice Pattern. November 2018. Available at: https://www.aao.org/preferred-practice-pattern/dry-eye-syndrome-ppp-2018. Accessed January 6, 2024. 
3. Xiidra [package insert]. Hanover, NJ: Novartis Pharmaceuticals Corporation: June 2020. 
4. Restasis [package insert]. Irvine, CA: Allergan, Inc.; July 2017 
5. Restasis MultiDose [package insert]. Irvine, CA: Allergan, Inc.; October 2016. 
6. Tyrvaya [package insert]. Princeton NJ: Oyster Point Pharma, Inc; October 2021 
7. Cequa [package insert]. Cranbury, NJ: Sun Pharmaceutical Industries, Inc; December 2022. 
8. Miebo [package insert]. Bridgewater, NJ: Bausch & Lomb Americas Inc; May 2023. 
9. ClinicalTrials.gov. CyclASol for the Treatment of Moderate to Severe dry-eye disease (DED). Avaialble at: https://www.clinicaltrials.gov/study/NCT02617667?cond=NCT02617667&rank=1. Accessed January 6, 2024. 
10. ClinicalTrials.gov. ESSENCE 2: CyclASol for the Treatment of Signs and Symptoms of Dry Eye Disease (DED). Avaialble at: https://www.clinicaltrials.gov/study/NCT04523129?cond=nct04523129&rank=1. Accessed January 6, 2024.