MedicaidPrior AuthHigh impact
Lucentis® (ranibizumab) (New)
Humana·OH · Ophthalmology, Endocrinology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Lucentis (ranibizumab) injections effective October 1, 2025. All five covered indications (wet AMD, diabetic macular edema, diabetic retinopathy, macular edema following RVO, and myopic choroidal neovascularization) require prior authorization and must demonstrate contraindication, intolerance, or failure to respond to bevacizumab before Lucentis approval.
Action Required
By October 1, 2025: Update prior authorization system to require approval for all Lucentis (ranibizumab) injections for Humana Medicaid Ohio patients. Train staff to document contraindication, intolerance, or bevacizumab failure before submitting requests. Update encounter forms to remind providers of bevacizumab trial requirement. Claims will be denied without proper prior authorization.