MedicaidPrior AuthMedium impact
Syfovre® (pegcetacoplan) intravitreal solution (New)
Humana·IN · Ophthalmology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Syfovre (pegcetacoplan) intravitreal injections used to treat geographic atrophy secondary to age-related macular degeneration. Prior authorization will be required starting February 1, 2026, with specific criteria including diagnosis confirmation and prescription by an ophthalmologist or retinal specialist.
Action Required
Before February 1, 2026: Billing team must update prior authorization requirements for Syfovre (pegcetacoplan) intravitreal injections for Humana Medicaid Indiana patients. Ensure providers document geographic atrophy diagnosis secondary to AMD and confirm prescription is by or in consultation with ophthalmologist or retinal specialist. Visit www.humana.com/PAL for applicable medical and procedural coding information. Failure to obtain prior authorization will result in claim denials.