MedicaidPrior AuthMedium impact
Susvimo® (ranibizumab) (Revised)
Humana·LA · Ophthalmology·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has updated prior authorization requirements for Susvimo (ranibizumab) intravitreal injections for treating wet AMD, diabetic macular edema, and diabetic retinopathy. All patients must have failed or be intolerant to bevacizumab and have received at least 2 prior VEGF inhibitor injections before approval.
Action Required
Immediately: For Louisiana Medicaid patients requiring Susvimo injections, billing team must obtain prior authorization by documenting: 1) Specific diagnosis (wet AMD, DME, or DR), 2) Use with Susvimo ocular implant, 3) Contraindication/intolerance to bevacizumab OR lack of positive clinical response, and 4) History of at least 2 prior VEGF inhibitor injections. Visit www.humana.com/PAL for specific procedure codes. Claims will be denied without proper prior authorization.