Medicare AdvantagePrior AuthHigh impact
Iluvien® (fluocinolone acetonide) intravitreal implant (Revised)
Humana·FL, KY, SC · Ophthalmology·Medicaid
Effective date
Jun 24, 2026
We identified it
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.
Action Required
By June 24, 2026: Billing and clinical teams must implement prior authorization requirements for Iluvien intravitreal implant across Medicaid plans (Florida, Kentucky, South Carolina) and Medicare. For DME cases: verify documentation of prior corticosteroid course AND confirm no clinically significant intraocular pressure elevation before submitting authorization requests. For uveitis cases: confirm posterior segment involvement. For BOTH indications: deny or flag for medical review if cup-to-disc ratio is documented as >0.8 (advanced glaucoma exclusion). Update billing system to route Iluvien claims to prior auth workflow. Train providers to document intraocular pressure response to prior steroids and glaucoma status on all Iluvien requests. Claims submitted without appropriate prior authorization or missing required documentation will be denied. Obtain current policy directly from Humana's online portal before submission, as printed versions become uncontrolled.