MedicaidPrior AuthMedium impact
Ozurdex® (dexamethasone intravitreal implant) (New)
Humana·OH · Ophthalmology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Ozurdex (dexamethasone intravitreal implant) for Ohio Medicaid patients, effective January 1, 2026. The policy requires prior auth for three specific eye conditions but excludes patients with advanced glaucoma or certain lens complications.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Ozurdex (dexamethasone intravitreal implant) treatments for Ohio Medicaid patients. Verify patients meet criteria for macular edema due to BRVO/CRVO, non-infectious posterior segment uveitis, or diabetic macular edema, and ensure they do not have exclusions (advanced glaucoma, aphakic eyes with ruptured posterior lens capsule, or ACIOL with ruptured posterior lens capsule). Update billing system to flag these cases for prior auth before treatment.