CurrentUnitedHealthcarePolicy N/A

Oxervate (cenegermin-bkbj) ophthalmic solution prior authorization

Defines UnitedHealthcare prior authorization requirements for Oxervate (cenegermin-bkbj) for treatment of neurotrophic keratitis for affected members and prescribing providers.

Policy Summary

PayerUnitedHealthcare

PolicyOxervate (cenegermin-bkbj) ophthalmic solution prior authorization

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMay 1, 2025

Next Review DateFeb 1, 2025

Key ActionObtain prior authorization for Oxervate; approvals are issued for an 8 week authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Stage 2 or 3required diagnosis stage for approval

8 weeksauthorization duration per approval

Prior Authprogram type

2019-2025policy review history

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage may be affected by state mandates, federal regulatory requirements, and the member’s specific benefit plan. These requirements can exclude, limit, or modify coverage under this policy. Other UnitedHealthcare policies and utilization management programs may also apply and affect approval or benefit determination.

Coding and Authorization Details

Document references ICD10 diagnosis codes and claim logicICD-10

No codes listed

Authorization duration

Authorization durationOne 8-week authorization per approval

Reauthorization timingAuthorization may be reissued per policy clinical review (not specified in document)

Impact of mandatesState mandates, federal regulatory requirements, and member-specific benefit plans may modify the authorization period

Provider Actions and Authorization Requirements

Prior Authorization

Prior Authorization Required — Prior authorization/notification is required

Prior authorization/notification is required. When approved, authorization will be issued for one 8 week authorization.

Authorization duration: one 8 week authorization
State mandates and member-specific benefit plan coverage may affect coverage

Step Therapy

No step therapy requirements specified

No step therapy requirements are specified in this policy.

Documentation Required

Administrative approval possible based on claims/diagnosis history

UnitedHealthcare may approve initial and reauthorization based solely on previous claim/medication history, diagnosis codes (ICD-10) and/or other administrative claim logic. Use of automated approval and re-approval processes varies by program/therapeutic class. Supply limits may be in place.

Denial Risk

Denial risk — Diagnosis requirement

Denial risk — Absence of a diagnosis of Stage 2 or 3 neurotrophic keratitis would trigger denial.

Required diagnosis: Stage 2 or 3 neurotrophic keratitis (ICD-10)

Background

Oxervate (cenegermin-bkbj) ophthalmic solution is a recombinant human nerve growth factor indicated for the treatment of neurotrophic keratitis. Under this program, approval is contingent on a documented diagnosis of Stage 2 or 3 neurotrophic keratitis. When authorized, coverage is issued as one 8 week authorization, and applicable state or federal requirements and member benefit provisions may further influence coverage.