Medicare AdvantagePrior AuthHigh impact
Lucentis® (ranibizumab) (Revised)
Humana·FL, KY, SC · Ophthalmology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has revised their Lucentis (ranibizumab) prior authorization policy for retinal conditions. The policy requires prior authorization for Lucentis injections and mandates step therapy with bevacizumab first, unless contraindicated or previously failed, with exceptions for Florida Medicaid and Medicare Part B continuations.
Action Required
Effective January 1, 2025: Billing team must ensure prior authorization is obtained for all Lucentis (ranibizumab) intravitreal injections. Providers must document contraindication/intolerance to bevacizumab OR prior bevacizumab therapy failure before Lucentis authorization. Update encounter forms to remind providers of step therapy requirements. Claims will be denied without proper prior authorization.