MedicaidPrior AuthMedium impact
Durysta® (bimatoprost implant) (New)
Humana·IN · Ophthalmology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Durysta (bimatoprost implant) effective January 1, 2026. This ophthalmology drug requires prior auth for treating open angle glaucoma or ocular hypertension, with specific exclusion criteria including corneal endothelial cell dystrophy and prior corneal transplantation.
Action Required
By January 1, 2026: Ophthalmology providers and billing staff must obtain prior authorization before prescribing or billing for Durysta (bimatoprost implant) for Indiana Medicaid patients. Update billing system to flag this medication for prior auth requirements. Ensure documentation includes diagnosis of open angle glaucoma or ocular hypertension and confirms patient has not received prior Durysta treatment in the affected eye. Verify absence of exclusion criteria including corneal endothelial cell dystrophy, prior corneal transplantation, or absent/ruptured posterior lens capsule. Claims submitted without prior authorization will be denied.