Restrictions and Criteria for 50 mg/mL, 1 mL use:

• 50 mg/mL, 1 mL Restricted to Ophthalmolgy for treatment of Ocular Surface Squamous Neoplasm (OSSN)
• After having tried and failed Interferon a2b

Restricted and Criteria for 50 mg/mL use:
      50 mg/mL for use by clinics and procedural area for hypertrophic scars and keloids:

• Prior authorization for medication/procedure 
• Tried and failed surgical treatment (e.g. surgical excision, cryosurgery)

AND/OR

• Tried and failed pharmacologic treatment (e.g. topical or intralesional corticosteroids, interferon, retinoic acid)

AND

• Experiencing or avoiding longer term adverse effects of corticosteroids

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