MedicaidPrior AuthMedium impact
Syfovre® (pegcetacoplan) intravitreal solution (New)
Humana·OH · Ophthalmology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Syfovre (pegcetacoplan) intravitreal solution, effective February 1, 2026. This medication requires prior authorization for treatment of geographic atrophy secondary to age-related macular degeneration and must be prescribed by or in consultation with an ophthalmologist or retinal specialist.
Action Required
By February 1, 2026: Billing team must implement prior authorization requirements for Syfovre (pegcetacoplan) intravitreal solution for Ohio Medicaid patients. Update billing system to flag this medication and ensure prescriptions include diagnosis of geographic atrophy secondary to AMD and are prescribed by or in consultation with an ophthalmologist or retinal specialist. Claims without proper prior authorization will be denied.