MedicaidPrior AuthMedium impact
Susvimo® (ranibizumab) (Revised)
Humana·IN · Ophthalmology, Endocrinology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has revised prior authorization requirements for Susvimo (ranibizumab) intravitreal solution used to treat wet AMD, diabetic macular edema, and diabetic retinopathy. All patients must have tried bevacizumab first and had at least 2 prior VEGF inhibitor injections before Susvimo can be approved.
Action Required
Before November 1, 2025: Billing team must update prior authorization protocols for Susvimo (ranibizumab) for Indiana Medicaid patients. Ensure providers document contraindication/intolerance to bevacizumab OR lack of positive clinical response to bevacizumab, plus history of at least 2 prior VEGF inhibitor injections. Update EMR templates to capture required clinical criteria. Claims will be denied without proper prior authorization meeting all four criteria.