Medicare AdvantagePrior AuthMedium impact
Susvimo® (ranibizumab) (Revised)
Humana·FL, KY, SC · Ophthalmology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization requirements for Susvimo (ranibizumab) intravitreal injections used to treat wet AMD, diabetic macular edema, and diabetic retinopathy. The policy requires step therapy with other VEGF inhibitors and specific documentation of treatment failure before approval.
Action Required
By January 1, 2025: Billing team must ensure prior authorization is obtained for all Susvimo (ranibizumab) intravitreal injections. Providers must document previous treatment with required VEGF inhibitors (bevacizumab for Medicaid, specific alternatives for Medicare) and attest to treatment failure or contraindications. Update encounter forms to remind providers of step therapy requirements. Claims will be denied without proper prior authorization.