MedicaidPrior AuthMedium impact
Encelto™ (revakinagene taroretcel-lwey) implant (New)
Humana·OH · Ophthalmology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid-Ohio has established a new prior authorization policy for Encelto (revakinagene taroretcel-lwey) intravitreal implant, effective December 1, 2025. This innovative cell-based therapy treats idiopathic macular telangiectasia type 2 (MacTel) and requires strict clinical criteria including confirmed diagnosis by imaging, patient age 18+, and specialist consultation.
Action Required
Before December 1, 2025: Billing and prior authorization teams must implement new prior auth requirements for Encelto implant requests for Ohio Medicaid patients. Ensure documentation includes clinical imaging confirming MacTel diagnosis, patient age verification, ophthalmologist/retinal specialist diagnosis, no active neovascular MacTel, and no previous Encelto treatment in operative eye. Claims without proper prior authorization will be denied.