Medicare AdvantagePrior AuthMedium impact
Cimerli® (ranibizumab-eqrn) (New)
Humana·Ophthalmology·Medicare Advantage
We identified it
Jul 1, 2026
Summary
Humana Medicare Advantage has implemented a new Prior Authorization policy for Cimerli® (ranibizumab-eqrn), a ranibizumab biosimilar used for retinal conditions. Billing teams must obtain prior authorization before administering this drug to Medicare Advantage members to avoid claim denials.
Action Required
Immediately: Billing and clinical teams must implement prior authorization procedures for Cimerli® (ranibizumab-eqrn) for all Humana Medicare Advantage members. (1) Update billing system to flag Cimerli® claims as requiring prior authorization before submission. (2) Obtain prior authorization from Humana before administering the drug. (3) Train clinical and administrative staff on the new requirement. (4) Update encounter documentation templates to include prior authorization tracking fields. Failure to obtain prior authorization will result in claim denials and potential member liability.