Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Forms and Documents Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for the member portal Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Rho Kinase Inhibitors Prior Authorization Criteria – Medicare Part D
Medicare Utilization Management Policy
Version Date: 01/01/2023

Prior Authorization Criteria for Approval

Initial Evaluation

Rhopressa and Rocklatan will be approved when BOTH of the following are met:

  1. The patient has a diagnosis of open-angle glaucoma or ocular hypertension
    AND
  2. ONE of the following:
    1. The patient has tried and failed at least ONE generic ophthalmic prostaglandin (e.g., latanoprost)
      OR
    2. The patient has an intolerance or hypersensitivity to ONE generic ophthalmic prostaglandin (e.g., latanoprost)
      OR
    3. The patient has an FDA labeled contraindication to ONE generic ophthalmic prostaglandin (e.g., latanoprost)

Length of approval: 12 months

Renewal Evaluation

Rhopressa and Rocklatan will be approved when ALL of the following are met:

  1. The patient has been previously approved for the requested medication through the plan’s Prior Authorization criteria
    AND
  2. The patient has a diagnosis of open-angle glaucoma or ocular hypertension
    AND
  3. The patient has had clinical benefit with the requested medication

Length of approval: 12 months
About Us Newsroom Blog Member Forms Transparency in Coverage Find Care Rights & Responsibilities Policies & Best Practices Privacy Policy Website User Agreement Fraud & Abuse Technical Information Contact Us Locations Careers Developers

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

Information in other languages: Español   中文   Tiếng Việt   한국어   Français   العَرَبِيَّة   Hmoob   ру́сский   Tagalog   ગુજરાતી   ភាសាខ្មែរ   Deutsch   हिन्दी   ລາວ   日本語

© 2026 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.