CommercialPrior AuthMedium impact
Ophthalmic Anti-Inflammatory Medications
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology·Medical Policy
We identified it
Jun 20, 2026
Summary
This BCBS Mississippi policy requires prior authorization for all ophthalmic anti-inflammatory medications including Acuvail, Ilevro, Nevanac, and Prolensa. Only Nevanac 0.1% may be approved for cataract surgery patients who have failed two generic alternatives, while the other three branded medications are considered not medically necessary.
Action Required
Immediately: Billing team must verify prior authorization requirements for all ophthalmic anti-inflammatory prescriptions (Acuvail, Ilevro, Nevanac, Prolensa) before dispensing. For Nevanac requests, ensure documentation shows patient is 10+ years old, having cataract extraction, and has failed two generic alternatives (diclofenac, flurbiprofen, or ketorolac) or has documented contraindications. Claims submitted without proper prior authorization will be denied.