Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors
Coverage policy for intravitreal vascular endothelial growth factor (VEGF) and dual VEGF/Ang-2 inhibitor medications used to treat ophthalmologic conditions for Colorado Rocky Mountain Health Plans members.
Ahzantive (aflibercept-mrbb), Enzeevu (aflibercept-abzv), Eydenzelt (aflibercept-boav), Nufymco (ranibizumab-leyk), Opuviz (aflibercept-yszy), and Yesafili (aflibercept-jbvf) have been added to the Review at Launch program and some members may not be eligible for coverage of this medication at this time.
Revised list of applicable VEGF and dual VEGF/Ang-2 inhibitors to include any U.S. FDA-approved ophthalmologic VEGF or dual VEGF/Ang-2 inhibitor product not listed in the policy, which will be considered non-preferred until reviewed by UnitedHealthcare.
Avastin, Cimerli, Eylea, Eylea HD, Lucentis, Pavblu, and Vabysmo are designated as preferred ophthalmologic VEGF or dual VEGF/Ang-2 inhibitor products; coverage is contingent on coverage criteria in the General Requirements and Diagnosis-Specific Criteria sections.
Coverage for Beovu, Byooviz, or other non-preferred ophthalmologic VEGF or dual VEGF/Ang-2 inhibitor products will be provided contingent on Preferred Product Criteria, General Requirements, and Diagnosis-Specific Criteria.
Members already on Beovu, Byooviz, or other non-preferred agents will be required to change therapy to a preferred product unless they meet Preferred Product Criteria (including history of trial of preferred agents with minimal response and physician attestation that non-preferred product would be superior).
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