BESIVANCE FORMULARY LOOKUP

We know that insurance coverage is important, so we created this tool to help you determine your patient’s coverage for BESIVANCE in 3 quick steps.

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Brand Status

Restrictions

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Tier Classifications

TIER 1
Usually, these are generic drugs available at the lowest co-pay.
TIER 2
Usually, these are “preferred” (or on formulary) brand name drugs.
TIER 3
Usually, these are "non-preferred" brand drugs, which require higher-level co-pay.
TIER 4-9
Usually, these are "non-preferred" brand drugs or specialty prescription products, which require higher-level co-pay.

Tier Definitions

N/C
Not Covered: This plan does not cover the drug.
N/A
Not Available: We are not able to provide formulary data for this drug/healthcare plan.

Please note: Plans and formulary information are subject to change. Please contact the prescription drug benefit provider for current formulary information.

Restrictions

PA
Prior Authorization: A drug that requires additional documentation before a prescription is approved and filled. Specific clinical criteria must be met prior to the approval.
QL
Quantity Limits: For safety and cost reasons, plans may set quantity limits on the amount of drugs they cover over a certain period of time.
ST
Step Therapy: A drug written for step therapy; restrictions for such a drug usually require that certain criteria be met before a prescription is approved.
 
Indication

BESIVANCE® (besifloxacin ophthalmic suspension) 0.6% is a quinolone antimicrobial indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following bacteria: Aerococcus viridans*, CDC coryneform group G, Corynebacterium pseudodiphtheriticum*, Corynebacterium striatum*, Haemophilus influenzae, Moraxella catarrhalis*, Moraxella lacunata*, Pseudomonas aeruginosa*, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis*, Staphylococcus lugdunensis*, Staphylococcus warneri*, Streptococcus mitis group, Streptococcus oralis, Streptococcus pneumoniae, Streptococcus salivarius*

*Efficacy for this organism was studied in fewer than 10 infections.

Important Safety Information
  • BESIVANCE is not for injection into the eye.
  • As with other anti-infectives, prolonged use of BESIVANCE may result in overgrowth of non-susceptible organisms, including fungi. If super-infection occurs, discontinue use and institute alternative therapy.
  • Patients should not wear contact lenses if they have signs or symptoms of bacterial conjunctivitis or during the course of therapy with BESIVANCE.
  • The most common adverse event reported in approximately 2% of patients treated with BESIVANCE was conjunctival redness. Other adverse events reported in patients receiving BESIVANCE occurring in approximately 1-2% of patients included: blurred vision, eye pain, eye irritation, eye pruritus and headache.
  • Safety and effectiveness in infants below one year of age have not been established.

Click here for full Prescribing Information for BESIVANCE.

Indication

BESIVANCE® (besifloxacin ophthalmic suspension) 0.6% is a quinolone antimicrobial indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following bacteria: Aerococcus viridans*, CDC coryneform group G, Corynebacterium pseudodiphtheriticum*, Corynebacterium striatum*, Haemophilus influenzae, Moraxella catarrhalis*, Moraxella lacunata*, Pseudomonas aeruginosa*, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis*, Staphylococcus lugdunensis*, Staphylococcus warneri*, Streptococcus mitis group, Streptococcus oralis, Streptococcus pneumoniae, Streptococcus salivarius*

*Efficacy for this organism was studied in fewer than 10 infections.

Important Safety Information
  • BESIVANCE is not for injection into the eye.
  • As with other anti-infectives, prolonged use of BESIVANCE may result in overgrowth of non-susceptible organisms, including fungi. If super-infection occurs, discontinue use and institute alternative therapy.
  • Patients should not wear contact lenses if they have signs or symptoms of bacterial conjunctivitis or during the course of therapy with BESIVANCE.
  • The most common adverse event reported in approximately 2% of patients treated with BESIVANCE was conjunctival redness. Other adverse events reported in patients receiving BESIVANCE occurring in approximately 1-2% of patients included: blurred vision, eye pain, eye irritation, eye pruritus and headache.
  • Safety and effectiveness in infants below one year of age have not been established.

Click here for full Prescribing Information for BESIVANCE.

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