Diagnosis: Glaucoma
Treatment: Vyzulta
The insurer denied Vyzulta.
The health plan's determination is overturned.

The patient is a male with Primary Open-Angle Glaucoma. The Ophthalmologist is seeking the use of Vyzulta as the patient has failed two prior eye medications (latanoprost and Travatan-Z). The patient was treated with a sample of Vyzulta and demonstrated an excellent response by bringing the intraocular pressure down from 20 to 10 mmHg (millimeters of mercury). The patient reported tolerating the Vyzulta a lot better.

Vyzulta is medically necessary for this patient.

Vyzulta was tried and shown to be effective at lowering intraocular pressure and was well tolerated in this patient. Vyzulta would be considered medically necessary to control this patient's intraocular pressure. The patient was unable to tolerate or failed two previous medications, but Vyzulta was demonstrated to work.