Medicare AdvantageCoverageMedium 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
Medicare Advantage updated their VEGF injection policy effective August 3, 2026, adding Ranibizumab-leyk (Nufymco®) as covered and establishing a new requirement that inadequate response must be determined after at least 3 monthly injections. The policy maintains a 3-level preferred product hierarchy with bevacizumab as Level 1 preferred.
Action Required
By August 3, 2026: Update prior authorization and billing protocols to include Ranibizumab-leyk (Nufymco®) as a Level 3 nonpreferred product requiring documentation of contraindication, intolerance, or inadequate response to both Level 1 and Level 2 products. Ensure documentation shows at least 3 monthly injections before determining inadequate response for all VEGF products. Update EMR templates to capture this requirement for Medicare Advantage intravitreal injection claims.