Diagnosis: Vision-dry eyes.
Treatment: Pharmacy/Prescription Drugs.

The insurer denied Xiidra.
The denial is overturned.

The patient is female with diagnosis of dry eye disease and meibomian gland dysfunction. The patient failed artificial tears for treatment of the dry eyes and is recommended to use Xiidra for the treatment of dry eyes. The patient has 3+ superficial punctate keratopathy of the left eye. The subject under review is the medical necessity for Xiidra.

The requested Xiidra is medically necessary for this patient.

Xiidra is a medication to help treat the signs and symptoms of dry eyes. Xiidra has been studied in more than 1000 patients with dry eye in 4 separate, 12-week clinical studies. In some patients at 12 weeks, Xiidra was shown to reduce dry eye symptoms in all 4 studies and Inferior fluorescein Corneal Staining score in 3 of 4 studies.
The patient does demonstrate a history of meibomian gland dysfunction with superficial punctate keratitis and dry eye disease as well as symptoms of dry eyes. Artificial tears were attempted but the patient failed treatment. Xiidra would be appropriate to use in this patient to further attempt the relief of the dry eye.