Clinical Policy: Lifitegrast (Xiidra)
Defines medical necessity criteria, prior authorization expectations, dosing/quantity limits, and continuation criteria for lifitegrast (Xiidra) for treatment of signs and symptoms of dry eye disease for commercial, HIM, and Medicaid lines of business.
Added requirement for topical anti-inflammatory agents and reduced number of wetting agents required from 2 to 1 (removed duration of trial).
Clarified that redirection to alternative agents are required unless clinically significant adverse effects or contraindications exist.
Appendix B consolidated therapeutic alternatives and added asterisks noting prior authorization may be required for certain alternatives.
Clarified off-label uses for ophthalmic anti-inflammatory agents and added Appendix D guideline info.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.