Dexamethasone Ophthalmic Implant (Ozurdex) and Insert (Dextenza) (CPB 0795, reviewed 2026-07-13)
Summary
Aetna considers Ozurdex (dexamethasone intravitreal implant) medically necessary for macular edema secondary to branch or central retinal vein occlusion, non-infectious uveitis affecting the posterior segment of the eye, and diabetic macular edema. Ozurdex is not medically necessary for members with ocular or periocular infections, advanced glaucoma, aphakic eyes with rupture of the posterior lens capsule, or a non-intact posterior lens capsule. Aetna considers Ozurdex experimental and investigational for many other indications, including acute zonal occult outer retinopathy, Coats' disease, cystoid macular edema following cataract surgery, and combined cataract surgery with Ozurdex. Dextenza (dexamethasone ophthalmic insert) is covered for ocular inflammation and pain following ophthalmic surgery, and for ocular itching associated with allergic conjunctivitis after failure of topical antihistamines with mast cell-stabilizing properties, topical mast cell stabilizers, and topical ophthalmic corticosteroids, unless contraindicated or clinically significant adverse effects are experienced. Dextenza is not medically necessary for members with active ocular infection.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.