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Iluvien® (fluocinolone acetonide) intravitreal implant (New)
Act
by Sep 1, 2026
Effective date
Sep 1, 2026
Identified
Sep 2, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Iluvien® (fluocinolone acetonide) intravitreal implant effective September 1, 2026. The policy covers two indications: diabetic macular edema (DME) requiring prior corticosteroid treatment without significant intraocular pressure rise, and chronic non-infectious uveitis affecting the posterior segment. Advanced glaucoma (cup-to-disc ratio >0.8) is a contraindication that will result in denial.
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What to do
by Sep 1, 2026 · 7 steps
01Billing team must establish prior authorization submission workflow for Iluvien intravitreal implant procedures in the Humana Medicaid Ohio system.
02Update encounter forms and EMR templates to capture required approval criteria: documented DME diagnosis with history of corticosteroid treatment and no clinically significant IOP rise, OR documented chronic non-infectious posterior uveitis diagnosis.
03Establish clinical review checklist to exclude patients with advanced glaucoma (cup-to-disc ratio >0.8) before submission.
04Configure billing system to flag all Iluvien claims for Medicaid Ohio members as requiring prior authorization.
05Train providers and coding staff on the two covered indications and exclusion criteria.
06Note: Approval is limited to plan year duration; establish renewal tracking process.
07Claims submitted without prior authorization or for excluded indications will be denied by Humana.
Original notice
Iluvien® (fluocinolone acetonide) intravitreal implant (New)
mcp.humana.com · Always check the source before changing claims.