MedicaidPrior AuthMedium impact
Aflibercept Products (Eylea®, Eylea® HD, Pavblu™) (New)
Humana·IN · Ophthalmology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Aflibercept products (Eylea, Eylea HD, Pavblu) for Indiana Medicaid effective March 1, 2026. Requires step therapy with bevacizumab first for most retinal conditions, with exceptions for vision 20/50 or worse in certain diagnoses.
Action Required
Before March 1, 2026: Ophthalmology practices treating Indiana Medicaid patients must obtain prior authorization for all Aflibercept products (Eylea, Eylea HD, Pavblu). Update prior authorization workflows to document bevacizumab contraindication, intolerance, or lack of positive response. For DME and DR cases, note that step therapy requirement is waived for patients with 20/50 or worse vision. Claims will require plan year duration approvals.