Medicare AdvantagePrior AuthHigh impact
Cimerli® (ranibizumab-eqrn) (New)
Humana·KY, SC · Ophthalmology·Medicaid
We identified it
Aug 1, 2026
Summary
Humana has issued a new Prior Authorization policy for Cimerli® (ranibizumab-eqrn), a biologic treatment, affecting Medicare and Medicaid members in Kentucky and South Carolina. This policy establishes authorization requirements for this drug and requires billing teams to implement prior auth procedures immediately.
Action Required
Immediately: Billing team must implement prior authorization requirements for Cimerli® (ranibizumab-eqrn, HCPCS J2778) for all Humana Medicare and Medicaid members in Kentucky and South Carolina. Update billing system to flag claims for prior auth approval before submission. Notify providers and clinical staff to obtain authorization before administering this drug. Access the full policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a593633 for specific clinical criteria and authorization procedures. Claims submitted without prior authorization will be denied.