Medicare AdvantageCoverageMedium 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·Pharmacy
Effective date
Aug 3, 2026
We identified it
Jun 16, 2026
Summary
Medicare Advantage policy updates VEGF antagonist coverage for eye injections, adding ranibizumab-leyk (Nufymco) as covered and requiring at least 3 monthly injections to document inadequate response before moving to higher-tier products. The policy establishes a 3-tier preferred product system with bevacizumab as Level 1 preferred.
Action Required
Before August 3, 2026: Billing team must update prior authorization workflows to document at least 3 monthly injections at FDA-approved doses before requesting coverage for Level 2 or Level 3 VEGF products. Update encounter forms to remind providers of the 3-tier preference system (bevacizumab Level 1, ranibizumab Level 2, all others Level 3). Add ranibizumab-leyk (Nufymco) to covered drug lists as a Level 3 nonpreferred product.