CommercialPrior AuthHigh impact
Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Ophthalmology·Pharmacy
Effective date
Aug 3, 2026
We identified it
Jun 18, 2026
Summary
Insurance company has designated bevacizumab as the preferred Level 1 treatment for intravitreal injections, with ranibizumab as Level 2, requiring step therapy and documentation of inadequate response (after 3 monthly injections) before approving higher-tier VEGF antagonists. Ranibizumab-leyk (Nufymco) was added as a covered but non-preferred Level 3 option.
Action Required
By August 3, 2026: Billing team must update prior authorization processes to require documentation of contraindication, intolerance, or inadequate response to bevacizumab before approving Level 2 products (ranibizumab/Lucentis), and inadequate response to BOTH Level 1 AND Level 2 products before approving Level 3 products (Eylea, Beovu, Vabysmo, etc.). Document that inadequate response requires at least 3 monthly injections at FDA-approved doses. Update encounter forms to remind providers of step therapy requirements for ophthalmology procedures.