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Brand Status

Restrictions

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Tier Classifications

TIER 1
Usually, these are generic drugs available at the lowest co-pay.
TIER 2
Usually, these are “preferred” (or on formulary) brand name drugs.
TIER 3
Usually, these are "non-preferred" brand drugs, which require higher-level co-pay.
TIER 4-9
Usually, these are "non-preferred" brand drugs or specialty prescription products, which require higher-level co-pay.

Tier Definitions

N/C
Not Covered: This plan does not cover the drug.
N/A
Not Available: We are not able to provide formulary data for this drug/healthcare plan.

Please note: Plans and formulary information are subject to change. Please contact the prescription drug benefit provider for current formulary information.

Restrictions

PA
Prior Authorization: A drug that requires additional documentation before a prescription is approved and filled. Specific clinical criteria must be met prior to the approval.
QL
Quantity Limits: For safety and cost reasons, plans may set quantity limits on the amount of drugs they cover over a certain period of time.
ST
Step Therapy: A drug written for step therapy; restrictions for such a drug usually require that certain criteria be met before a prescription is approved.
Indication

ALREX® (loteprednol etabonate ophthalmic suspension) 0.2% is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis.

Important Safety Information
  • ALREX is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of the ocular structures. ALREX is also contraindicated in individuals with known or suspected hypersensitivity to any of the ingredients of this preparation and to other corticosteroids.
  • Prolonged use of ALREX is associated with several warnings and precautions, including glaucoma with optic nerve damage, defects in visual acuity, cataract formation, secondary ocular infections, exacerbation or prolongation of viral ocular infections (including herpes simplex), delay in wound healing and increase in bleb formation.
  • If this product is used for 10 days or longer, intraocular pressure should be monitored. The initial prescription and renewal of the medication order beyond 14 days should be made by a physician only after reexamination of the patient with the aid of magnification. Fungal infections of the cornea may develop with prolonged use of corticosteroids.
  • Ocular adverse reactions occurring in 5-15% of patients treated with loteprednol etabonate ophthalmic suspension (0.2% - 0.5%) in clinical studies included abnormal vision/blurring, burning on instillation, chemosis, discharge, dry eyes, epiphora, foreign body sensation, itching, injection, and photophobia.

Click here for Prescribing Information for ALREX.

Indication

ALREX® (loteprednol etabonate ophthalmic suspension) 0.2% is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis.

Important Safety Information
  • ALREX is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of the ocular structures. ALREX is also contraindicated in individuals with known or suspected hypersensitivity to any of the ingredients of this preparation and to other corticosteroids.
  • Prolonged use of ALREX is associated with several warnings and precautions, including glaucoma with optic nerve damage, defects in visual acuity, cataract formation, secondary ocular infections, exacerbation or prolongation of viral ocular infections (including herpes simplex), delay in wound healing and increase in bleb formation.
  • If this product is used for 10 days or longer, intraocular pressure should be monitored. The initial prescription and renewal of the medication order beyond 14 days should be made by a physician only after reexamination of the patient with the aid of magnification. Fungal infections of the cornea may develop with prolonged use of corticosteroids.
  • Ocular adverse reactions occurring in 5-15% of patients treated with loteprednol etabonate ophthalmic suspension (0.2% - 0.5%) in clinical studies included abnormal vision/blurring, burning on instillation, chemosis, discharge, dry eyes, epiphora, foreign body sensation, itching, injection, and photophobia.

Click here for Prescribing Information for ALREX.

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