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HumanaMedicare Advantage · Prior Auth · Medicaid · FL, KY, SC · OphthalmologyHigh impact

Iluvien® (fluocinolone acetonide) intravitreal implant (Revised)

Act
by Jun 24, 2026
Effective date
Jun 24, 2026
Identified
Jun 25, 2026

Summary

This is a revision to Humana's Iluvien (fluocinolone acetonide) intravitreal implant prior authorization policy, effective June 24, 2026. The policy clarifies coverage for diabetic macular edema (DME) and chronic non-infectious uveitis affecting the posterior segment, requiring prior authorization with specific clinical criteria and exclusions. Key requirement: DME patients must have previous corticosteroid treatment without clinically significant intraocular pressure rise, and advanced glaucoma (cup-to-disc ratio >0.8) is a contraindication for both indications.

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What to do

by Jun 24, 2026 · 8 steps
01Billing and clinical teams must implement prior authorization requirements for Iluvien intravitreal implant across Medicaid plans (Florida, Kentucky, South Carolina) and Medicare.
02For DME cases: verify documentation of prior corticosteroid course AND confirm no clinically significant intraocular pressure elevation before submitting authorization requests.
03For uveitis cases: confirm posterior segment involvement.
04For BOTH indications: deny or flag for medical review if cup-to-disc ratio is documented as >0.8 (advanced glaucoma exclusion).
05Update billing system to route Iluvien claims to prior auth workflow.
06Train providers to document intraocular pressure response to prior steroids and glaucoma status on all Iluvien requests.
07Claims submitted without appropriate prior authorization or missing required documentation will be denied.
08Obtain current policy directly from Humana's online portal before submission, as printed versions become uncontrolled.

Original notice

Iluvien® (fluocinolone acetonide) intravitreal implant (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Iluvien® (fluocinolone acetonide) intravitreal implant (New)MediumEffective Sep 1, 2026 · MedicaidIluvien® (fluocinolone acetonide) intravitreal implant (New)MediumEffective Sep 1, 2026 · MedicaidBrowse every Humana change in the policy list

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Humana policiesFL policy changesKY policy changesSC policy changesOphthalmology

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