All PlansPrior AuthMedium impact
Aflibercept Products (Eylea®; Eylea®HD, Ahzantive™ [aflibercept-mrbb], Enzeevu™ [Afliberceptabzv], Eydenzelt® [Aflibercept-boav], Opuviz™ [Aflibercept-yszy], Pavblu™ [Aflibercept-ayyh], and Yesafili™ [Aflibercept-jbvf])
BCBS Tennessee·Ophthalmology·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
New comprehensive policy for aflibercept products (Eylea, Eylea HD, and multiple biosimilars) establishes coverage criteria, authorization periods, and quantity limits for retinal conditions. Policy requires 6-month initial authorization for covered indications with 12-month reauthorization based on clinical response.
Action Required
Before June 30, 2026: Billing team must implement prior authorization requirements for all aflibercept products (Eylea, Eylea HD, Ahzantive, Enzeevu, Eydenzelt, Opuviz, Pavblu, Yesafili) used for diabetic macular edema, diabetic retinopathy, neovascular age-related macular degeneration, macular edema following retinal vein occlusion, and retinopathy of prematurity. Update system to track 6-month initial authorization periods and 12-month reauthorization cycles. Configure quantity limits based on specific drug and indication combinations. Note that some agents may require step therapy - refer to separate step therapy guide.