Payer PolicyActive
Durysta™ (bimatoprost implant, for intracameral administration)
EVICORE-MEDICAL_DRUG-6C178F20
EviCore by Evernorth
Effective: July 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Durysta (bimatoprost intracameral implant) is covered only to reduce IOP in adults (≥18) with open‑angle glaucoma or ocular hypertension and is excluded for eyes previously treated with Durysta or for non‑FDA‑approved uses. Coverage requires documented inadequate efficacy or severe adverse events to at least two prostaglandin agents and to at least two agents from two other pharmacologic classes, prescription by or in consultation with an ophthalmologist, and is limited to one implant per treated eye (maximum two implants per patient).
Coverage Criteria Preview
Key requirements from the full policy
"Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension (FDA-approved indication)."
Sign up to see full coverage criteria, indications, and limitations.