CommercialPrior AuthMedium impact
State and School Employees' Health Insurance Plan - Intravitreal Angiogenesis Inhibitors
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi State and School Employees' Health Plan updated their policy for intravitreal angiogenesis inhibitors (eye injections for conditions like macular degeneration). The policy establishes a tier system where bevacizumab products (Avastin, Mvasi, Zirabev) are first-line covered options, while other drugs like Eylea and Lucentis require prior authorization with specific criteria including age restrictions and failure of bevacizumab therapy.
Action Required
Immediately: Ophthalmology billing team must update prior authorization workflows for intravitreal injections. Ensure bevacizumab products (Avastin, Mvasi, Zirabev) are billed as first-line without prior auth. For Eylea, Lucentis, Byooviz, and Pavblu, obtain prior authorization documenting patient age ≥18, specific diagnosis codes, and failure/contraindication of bevacizumab therapy. Note that several newer drugs (Beovu, Eylea HD, Vabysmo, etc.) are considered not medically necessary. Update encounter forms to capture required documentation elements.