MedicaidPrior AuthMedium impact
Cimerli® (ranibizumab-eqrn) (New)
Humana·LA · Ophthalmology·Medicaid
Effective date
Aug 1, 2026
We identified it
Aug 1, 2026
Summary
Humana Medicaid Louisiana is implementing a new prior authorization policy for Cimerli® (ranibizumab-eqrn), an ophthalmic VEGF inhibitor for retinal conditions. The policy requires step therapy—patients must have a contraindication/intolerance to bevacizumab OR demonstrate lack of clinical response to prior bevacizumab therapy before Cimerli coverage is approved. This affects five ophthalmologic indications and requires documentation of failed or unsuitable prior therapy.
Action Required
By August 1, 2026: (1) Billing team must update claims processing system to route all Cimerli requests through prior authorization workflow for Humana Medicaid Louisiana members. (2) Providers must be notified to submit prior auth requests with documentation of either: bevacizumab contraindication/intolerance, OR evidence that patient received bevacizumab previously and did NOT show improvement/maintenance in visual acuity, visual field, or reduction in vision decline rate. (3) Front desk/intake staff must flag all Cimerli prescriptions for the five covered indications (AMD, DME, DR, RVO, mCNV) to ensure prior auth is obtained before dispensing. (4) Update encounter forms/templates to require providers to document step therapy criteria. Failure to obtain prior authorization will result in claim denials.