Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors
Policy governing medical benefit coverage and authorization criteria for intravitreal vascular endothelial growth factor (VEGF) and dual VEGF/Ang-2 inhibitor medications for ophthalmologic conditions for Sierra Health and Life 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 at this time.
Any U.S. FDA-approved ophthalmologic VEGF or dual VEGF/Ang-2 inhibitor product not listed by name in this policy 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 and 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.
Preferred Product Criteria includes requirement for a trial of adequate dose and duration of preferred products resulting in minimal clinical response and a physician attestation that clinical response would be expected to be superior with the non-preferred product.
Reference links and language indicating that coverage for specific products was contingent on General Requirements and Diagnosis-Specific Requirements sections were removed.
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