Yutiq™
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
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411