Rhopressa™

Drug - Rhopressa™ (netarsudil) [Aerie Pharmaceuticals Inc.]

December 2018

Therapeutic area - Ophthalmics, Glaucoma Agents

Approval criteria

• Patient must be at least 18 years of age AND
• Patient has a diagnosis of ocular hypertension or open-angle glaucoma AND
• Patient has had an adequate trial and failure of a prostaglandin inhibitor AND beta-adrenergic antagonist or is to be used in conjunction with another medication for glaucoma AND
• Patient must not have had:
  • Previous glaucoma intraocular surgery or glaucoma laser procedure in the affected eye OR
  • Ocular surgery or laser treatment within 3 months prior to initiation AND
• Patient must not currently have:
  • Ocular infection OR
  • Inflammation OR
  • Blepharitis OR
  • Conjunctivitis OR
  • Ocular Disease

Renewal criteria

• Patient continues to meet above criteria AND
• Patient has demonstrated efficacy (e.g., reduction in IOP)

Quantity limits

• One bottle (2.5 mL fill) per affected eye per 30 days

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411