Visudyne® (verteporfin) (Revised)

By January 1, 2025, the billing team must: (1) Update the billing system and prior authorization workflow to require prior authorization for all Visudyne (verteporfin) claims submitted under Medicaid plans in Florida, Kentucky, South Carolina, and Virginia; (2) For Kentucky, South Carolina, and Virginia Medicaid: Verify that prior therapy, contraindication, or intolerance to bevacizumab intravitreal injection is documented before submitting authorization requests for age-related macular degeneration cases (this requirement does NOT apply to Florida Medicaid); (3) Configure the system to accept diagnoses of neovascular AMD, presumed ocular histoplasmosis, and pathologic myopia as eligible indications; (4) Set prior authorization approval durations to plan year duration for both initial and renewal requests; (5) Train billing staff and providers to always obtain prior authorization before dispensing Visudyne in these four states; (6) Update internal documentation requirements to capture bevacizumab history for non-Florida Medicaid claims. Failure to obtain prior authorization will result in claim denials and potential member liability.