MedicaidPrior AuthHigh impact
Provider Letter 2023-08: RE: Prior Authorization of Lucentis® – Effective 5/15/2023
Oklahoma SoonerCare·OK · Ophthalmology·Prior Authorization
Effective date
May 15, 2023
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid (SoonerCare) now requires prior authorization for LUCENTIS® (ranibizumab) injections effective May 15, 2023, with biosimilar alternatives BYOOVIZ™ and CIMERLI™ remaining available without prior auth. All patients, whether continuing or starting therapy, must have PA form PHARM-18 submitted to obtain approval.
Action Required
By May 15, 2023: Billing team must implement prior authorization requirements for LUCENTIS® injections for all SoonerCare members. Submit PA form PHARM-18 to Pharmacy Prior Authorization Unit (NOT Medical Authorization Unit) with patient-specific clinical justification why biosimilar alternatives BYOOVIZ™ or CIMERLI™ cannot be used. Include past dates of service for continuing patients. Update encounter forms to remind providers of PA requirement and preferred biosimilar alternatives. Claims will be denied without proper prior authorization.