MedicaidPrior AuthHigh impact
Aflibercept Products (Eylea®, Eylea® HD, Pavblu™) (New)
Humana·OH · Ophthalmology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Aflibercept products (Eylea, Eylea HD, Pavblu) for retinal conditions. All three products now require prior authorization with step therapy requirements through bevacizumab, except for patients with 20/50 or worse vision for certain conditions.
Action Required
Before March 1, 2026: Ophthalmology practices must update prior authorization workflows for Humana Medicaid Ohio members receiving Eylea, Eylea HD, or Pavblu injections. Document bevacizumab contraindications, intolerances, or lack of clinical response in medical records. For DME and DR cases, note that step therapy is waived for patients with 20/50 or worse vision. Train staff on new PA requirements to prevent claim denials.