Medicare AdvantagePrior AuthMedium impact
Byooviz® (ranibizumab-nuna) (Revised)
Humana·FL, KY, SC · Ophthalmology·Medicaid
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana updated its Byooviz (ranibizumab-nuna) prior authorization policy effective February 25, 2026, affecting Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The policy requires prior authorization for three ophthalmic conditions with a key exception: Florida Medicaid requests are exempt from bevacizumab step-therapy requirements, and Medicare Part B continuation therapy within 365 days bypasses step therapy.
Action Required
By February 25, 2026: Billing team must implement prior authorization requirements for all Byooviz claims across Medicare and applicable Medicaid plans. (1) Update prior auth verification in billing system to flag Byooviz requests for neovascular AMD, macular edema following RVO, and myopic choroidal neovascularization. (2) For Medicare Part B and Florida Medicaid: Document in system that step-therapy (bevacizumab failure/contraindication) requirements differ by plan—Florida Medicaid does NOT require step therapy; Medicare Part B does NOT require step therapy if continuation within past 365 days. (3) For Kentucky and South Carolina Medicaid: Ensure step-therapy documentation is collected (bevacizumab contraindication, intolerance, or failure to demonstrate clinical response). (4) Update provider communication templates to clarify that prior auth is required and to request necessary clinical documentation. (5) Train billing and clinical staff on the state-specific and Medicare-specific exemptions to avoid incorrect denials. Failure to obtain prior authorization will result in claim denials.