MedicaidPrior AuthHigh impact
Lucentis® (ranibizumab) (Revised)
Humana·LA · Ophthalmology·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has revised their prior authorization policy for Lucentis (ranibizumab) eye injections, requiring either bevacizumab contraindication/intolerance OR documented failure of bevacizumab therapy before approving Lucentis for all covered retinal conditions. This creates a step therapy requirement that may delay treatment approvals.
Action Required
Immediately: Ophthalmology billing team must ensure all Lucentis prior authorization requests for Humana Medicaid Louisiana members include documentation of either bevacizumab contraindication/intolerance OR prior bevacizumab therapy failure with provider attestation of no positive clinical response. Update prior auth templates to capture required bevacizumab history. Claims will be denied without proper step therapy documentation.