MedicaidPrior AuthMedium impact
Byooviz® (ranibizumab-nuna) (New)
Humana·IN · Ophthalmology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
New Medicaid policy for Byooviz (ranibizumab-nuna) intravitreal injections requires prior authorization for three retinal conditions, with coverage limited to patients who have contraindications to or failed bevacizumab therapy. This affects billing for ophthalmology practices treating wet AMD, macular edema following retinal vein occlusion, and myopic choroidal neovascularization.
Action Required
Before May 1, 2026: Ophthalmology billing teams must implement prior authorization requirements for Byooviz (ranibizumab-nuna) intravitreal injections for Indiana Medicaid patients. Update billing system to flag cases requiring documentation of bevacizumab contraindication, intolerance, or failed therapy. Train staff to obtain prior authorization before treatment and ensure providers document bevacizumab trial history or contraindications in medical records.