Aflibercept Products (Eylea®; Eylea®HD, Ahzantive™ [aflibercept-mrbb], Enzeevu™ [Aflibercept-abzv], Eydenzelt® [Aflibercept-boav], Opuviz™ [Aflibercept-yszy], Pavblu™ [Aflibercept-ayyh], and Yesafili™ [Aflibercept-jbvf])

By November 1, 2026: Billing team must review and prepare implementation of this aflibercept policy. Actions required: (1) Update prior authorization (PA) system to recognize all seven aflibercept biosimilar products and require 12-month authorizations for covered indications; (2) Configure quantity limits in billing software per the dosing tables provided (2mg or 8mg per affected eye at specified intervals depending on product and diagnosis); (3) Add requirement that prescribing provider must be an ophthalmologist or have ophthalmology consultation documented; (4) Create tracking mechanism for continuation of therapy reauthorizations requiring documentation of positive clinical response (BCVA improvement, visual field maintenance, or reduced vision decline); (5) Train billing and authorization staff on the four covered indications versus experimental/investigational uses; (6) Update fee schedules and claims processing rules. NOTE: This policy contains a step therapy requirement - billing team must cross-reference the BC Step Therapy Guide at the provided URL to determine which agents require step therapy prior to coverage. Failure to implement proper authorization requirements will result in claim denials.