MedicaidPrior AuthMedium impact
Ozurdex® (dexamethasone intravitreal implant) (New)
Humana·IN · Ophthalmology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Ozurdex (dexamethasone intravitreal implant) for Indiana Medicaid patients effective January 1, 2026. The policy establishes approval criteria for three eye conditions and lists specific exclusions that would prevent approval.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for Ozurdex (dexamethasone intravitreal implant) for Indiana Medicaid patients. Verify patients meet diagnostic criteria for macular edema (BRVO/CRVO), non-infectious posterior segment uveitis, or diabetic macular edema. Ensure patients do not have exclusions: advanced glaucoma, aphakic eyes with ruptured posterior lens capsule, or ACIOL with ruptured posterior lens capsule. Visit www.humana.com/PAL for specific billing codes. Claims without proper prior authorization will be denied.