ZIRGAN Formulary Lookup
We know that insurance coverage is important, so we created this tool to help you determine your patient's coverage for ZIRGAN in 3 quick steps.
- Step 1
- Step 2
- Step 3
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Select your patient’s plan type
Select your patient’s plan
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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
ZIRGAN® (ganciclovir ophthalmic gel) 0.15% is a topical ophthalmic antiviral that is indicated for the treatment of acute herpetic keratitis (dendritic ulcers).
Important Safety Information
- ZIRGAN is indicated for topical ophthalmic use only.
- Patients should not wear contact lenses if they have signs or symptoms of herpetic keratitis or during the course of therapy with ZIRGAN.
- Most common adverse reactions reported in patients were blurred vision (60%), eye irritation (20%), punctate keratitis (5%), and conjunctival hyperemia (5%).
- Safety and efficacy in pediatric patients below the age of 2 years have not been established.
Click here for full Prescribing Information for ZIRGAN.
ZIRGAN is a trademark of Laboratoires Théa Corporation used under license.
Indication
ZIRGAN® (ganciclovir ophthalmic gel) 0.15% is a topical ophthalmic antiviral that is indicated for the treatment of acute herpetic keratitis (dendritic ulcers).
Important Safety Information
- ZIRGAN is indicated for topical ophthalmic use only.
- Patients should not wear contact lenses if they have signs or symptoms of herpetic keratitis or during the course of therapy with ZIRGAN.
- Most common adverse reactions reported in patients were blurred vision (60%), eye irritation (20%), punctate keratitis (5%), and conjunctival hyperemia (5%).
- Safety and efficacy in pediatric patients below the age of 2 years have not been established.
Click here for full Prescribing Information for ZIRGAN.
ZIRGAN is a trademark of Laboratoires Théa Corporation used under license.
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