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Drug Yutiq™ (fluocinolone acetonide implant) [EyePoint Pharmaceuticals US, Inc.]

January 2020

Therapeutic area - Ophthalmics, Anti-inflammatories

Initial approval criteria

  • Patient is at least 18 years or older; AND
  • Patient has a diagnosis of chronic non-infectious uveitis affecting the posterior segment of the eye made by an ophthalmologist; AND
  • Yutiq must be prescribed by an ophthalmologist; AND
  • Prescriber documents patient has not previously received Yutiq within the last 36 months; AND
  • Patient is free of ocular or periocular infections; AND
  • Patient has had chronic disease for ≥ 1 year; AND
  • Other causes of uveitis have been ruled out (e.g., infectious, malignancy); AND
  • Yutiq will not be used in combination with other sustained-release intravitreal corticosteroids; AND
  • Patient must not be on concurrent Humira or any other biologics for uveitis; AND
  • Patient does not have any of the following:
    • Active or suspected ocular or periocular infections, including most viral disease of the cornea and conjunctiva (e.g., active epithelial herpes simplex keratitis [dendritic keratitis], vaccinia, varicella), OR
    • Mycobacterial infections, OR
    • Fungal diseases
  • Initial: Once per eye every 36 months

Renewal criteria

  • Patient continues to meet the above criteria; AND
  • Prescriber documents patient has received Yutiq previously, along with date(s) of use; AND
  • Absence of unacceptable toxicity from the drug (e.g., cataract formation, endophthalmitis, increased intra-ocular pressure); AND
  • Disease response as indicated by ≥ 1 of the following:
    • Stabilization of visual acuity or improvement in best-corrected visual acuity (BCVA) score when compared to baseline; OR
    • Improvement in vitreous haze score (decrease in inflammation).
  • Renewal: Once per eye every 36 months

Quantity limits

  • One 0.18 mg implant per eye/36 months


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

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