MedicaidPrior AuthHigh impact
Lucentis® (ranibizumab) (New)
Humana·OH · Ophthalmology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Lucentis® (ranibizumab) intravitreal injections for Ohio Medicaid members effective October 1, 2025. Prior authorization is required for all covered indications (wet AMD, diabetic macular edema, diabetic retinopathy, retinal vein occlusion, and myopic choroidal neovascularization), with approval contingent on having a contraindication to bevacizumab or documented failure to respond to bevacizumab therapy.
Action Required
By October 1, 2025: Billing team must update prior authorization requirements for all Lucentis (ranibizumab) intravitreal injections for Ohio Medicaid patients. Providers must document either contraindication/intolerance to bevacizumab OR prior bevacizumab therapy failure with attestation of no positive clinical response before administering Lucentis. Update EMR templates to capture required clinical criteria. Claims will be denied without proper prior authorization.