Oscar Commercial Clinical Policy

Oscar Nevanac (nepafenac) Ophthalmic Suspension (PG078) Form

Effective Date

11/05/2020

Last Reviewed

09/21/2023

Original Document

  Reference



Nevanac (nepafenac) is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation associated with cataract surgery. Cataracts are when cloudy, opaque areas develop on the lens of the eye which cause blurry vision. Cataract surgery is the removal of the cloudy lens and replacement of an artificial lens. Pain and inflammation are common post-operative symptoms of cataract surgery which can be treated with steroid or NSAID eye drops.

Definitions

  • Non-steroidal anti-inflammatory drug (NSAID) is a type of medication that is prescribed to reduce pain and inflammation.
  • Steroid is a class of medications used to reduce inflammation in various conditions, such as uveitis.
Medical Necessity Criteria for Authorization

The Plan considers Nevanac (nepafenac) medically necessary when ALL of the following criteria are met:

  1. The requested medication is being used for the management of ocular inflammation and pain associated with cataract surgery; AND
  2. The member is unable to use or has tried and failed ONE (1) of the following:
    • Bromfenac 0.09% Ophthalmic Solution; or
    • Diclofenac Sodium 0.1% Ophthalmic Solution; or
    • Ketorolac Tromethamine 0.5% Ophthalmic Solution; AND
  3. Clinical chart documentation is provided for review to substantiate the above listed requirements.

If the above prior authorization criteria is met, Nevanac (nepafenac) will be approved for 30-days.

Experimental or Investigational / Not Medically Necessary

Nevanac (nepafenac) for any other indication is considered not medically necessary by the Plan, as it is deemed to be experimental, investigational, or unproven.

References

  1. American Academy of Ophthalmology. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. Nov 2021. Available online: https://www.aao.org/preferred-practice-pattern/cataract-in-adult-eye-ppp-2021-in-press
  2. Helga, et al. A review of the use of ketorolac tromethamine 0.4% in the treatment of post-surgical inflammation following cataract and refractive surgery. Clin Ophthalmol. 2007 Dec; 1(4):367-371.
  3. Nevanac (nepafenac) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; September 2021.
Clinical Guideline Revision / History Information

Original Date: 11/05/2020
Reviewed/Revised: 10/14/2021, 12/01/2021, 9/15/2022, 9/21/2023