CommercialPrior AuthHigh impact
Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·PA · Ophthalmology, Endocrinology·Pharmacy
Effective date
Aug 3, 2026
We identified it
Jun 16, 2026
Summary
New policy establishes 3-tier preference system for VEGF eye injection drugs, requiring step therapy documentation and adding ranibizumab-leyk (Nufymco) as covered. Bevacizumab is preferred first-line, ranibizumab second-line, with all other drugs requiring failure of both preferred options.
Action Required
Before August 3, 2026: Billing team must update prior authorization workflows to document step therapy requirements for VEGF eye injections. For Level 2 drugs (ranibizumab), obtain documentation of contraindication, intolerance, or inadequate response to bevacizumab after 3 monthly injections. For Level 3 drugs (aflibercept, brolucizumab, faricimab), require failure of BOTH Level 1 and Level 2 drugs with 3 monthly injections each. Update encounter forms to remind providers of new step therapy requirements and add ranibizumab-leyk (Nufymco) to covered drug list.