MedicaidPrior AuthMedium impact
iDose® TR (travoprost) intracameral implant (Revised)
Humana·OH · Ophthalmology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana has implemented a revised prior authorization policy for iDose® TR (travoprost) intracameral implant effective January 1, 2026, with updates as of June 1, 2026. The policy establishes coverage criteria for Ohio Medicaid members with open-angle glaucoma or ocular hypertension, requiring prior authorization and screening for two key contraindications: corneal endothelial cell dystrophy and prior corneal transplantation. Billing teams must implement prior authorization requirements before the effective date.
Action Required
By December 15, 2025: Billing team and prior authorization staff must implement this new prior authorization requirement in the Humana system for Ohio Medicaid members. Update internal workflows to: (1) flag all iDose® TR (travoprost) intracameral implant requests for prior authorization review; (2) ensure clinical staff verify member meets diagnosis criteria (open-angle glaucoma or ocular hypertension); (3) confirm absence of exclusionary conditions (corneal endothelial cell dystrophy, prior corneal transplantation); (4) process approvals for initial and renewal plan year durations as specified. Contact Humana PAL (www.humana.com/PAL) for specific medical/procedural coding information. Train ophthalmology providers and billing staff on new requirements. Without prior authorization, claims will be denied for Ohio Medicaid members.