Medicare AdvantagePrior AuthLow impact
Encelto™ (revakinagene taroretcel-lwey) implant (Revised)
Humana·FL, KY, SC · Ophthalmology·Medicaid
Effective date
May 28, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Encelto (revakinagene taroretcel-lwey) intravitreal implant, effective May 28, 2025. This gene therapy treats Idiopathic Macular Telangiectasia Type 2 and requires documentation of clinical features, confirmation by ophthalmologist/retinal specialist, and patient age 18+.
Action Required
By May 28, 2025: Billing team must implement prior authorization requirements for Encelto (revakinagene taroretcel-lwey) implant claims for Humana Medicare and Medicaid FL/KY/SC members. Ensure providers document clinical features via imaging tests, confirmation by ophthalmologist/retinal specialist, patient age verification, and absence of active neovascular MacTel. Update system to flag this requires 6-month approval durations and cannot be used in previously treated eyes.