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DrugVyzulta™ (latanoprostene bunod) [Bausch & Lomb Inc.]

July 2018

Therapeutic area - Ophthalmics, Glaucoma

Approval criteria

  • Patient must be 17 years old or older AND
  • Patient must have a diagnosis of open-angle glaucoma or ocular hypertension AND
  • Patient must not have known hypersensitivity to latanoprostene bunod or its derivatives (e.g., latanoprost) AND
  • Patient must have an adequate 6-month trial and failure of at least 1 preferred ophthalmic beta blocker agent (e.g., timolol) AND 6-month trial and failure of at least one preferred prostaglandin analogue (e.g.,latanoprost or Travatan/Travatan Z)

Renewal criteria

  • Patient must continue to meet the above criteria AND
  • Patient must have documented efficacy as defined by a decrease in intraocular pressure AND
  • Patient must not have experienced any treatment-restricting adverse effects (e.g., significant conjunctival hyperemia, eye irritation, eye pain, and instillation site pain)

Quantity limits

  • 1 bottle per 34 days


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

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