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Iluvien® (fluocinolone acetonide) intravitreal implant (New)
Act
by Aug 25, 2026
Effective date
Sep 1, 2026
Identified
Sep 2, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Iluvien® (fluocinolone acetonide) intravitreal implant effective September 1, 2026. Coverage is limited to two indications: diabetic macular edema (DME) in patients with prior corticosteroid treatment and no significant intraocular pressure rise, and chronic non-infectious uveitis affecting the posterior segment. Advanced glaucoma (cup-to-disc ratio >0.8) is an absolute contraindication for both indications.
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What to do
by Aug 25, 2026 · 5 steps
01Billing team must configure billing system to flag all Iluvien claims for prior authorization review before submission to Humana Indiana Medicaid.
02Update internal encounter forms and provider templates to require documentation of: (a) for DME cases—diagnosis of diabetic macular edema AND evidence of prior corticosteroid course AND confirmation of no clinically significant IOP rise; (b) for uveitis cases—diagnosis of chronic non-infectious uveitis affecting posterior segment.
03Add validation rule to reject claims missing required clinical documentation.
04Train ophthalmology staff and billing team on the two distinct approval pathways and exclusion criteria.
05Distribute policy summary to all ophthalmologists and retinal surgeons in your network.
If missed: Failure to obtain prior authorization will result in claim denials from Humana Indiana Medicaid.
Original notice
Iluvien® (fluocinolone acetonide) intravitreal implant (New)
mcp.humana.com · Always check the source before changing claims.