MedicaidPrior AuthHigh impact
Lucentis® (ranibizumab) (Revised)
Humana·IN · Ophthalmology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has revised their Lucentis (ranibizumab) prior authorization policy requiring bevacizumab to be tried first or documented as contraindicated/ineffective for all covered retinal conditions. This applies to intravitreal injections for wet AMD, diabetic macular edema, diabetic retinopathy, retinal vein occlusion, and myopic choroidal neovascularization.
Action Required
Immediately: For all Lucentis injections for Humana Medicaid Indiana members, providers must document either contraindication/intolerance to bevacizumab OR prior bevacizumab therapy failure with attestation of no positive clinical response (improvement/maintenance in visual acuity, visual field, or reduction in vision decline). Update prior authorization forms and EMR templates to capture this required documentation. Claims will be denied without proper bevacizumab step therapy documentation.