Effective January 1, 2020, Avastin® and its
biosimilars (i.e., Mvasi™, Zirabev™) will be the preferred
intravitreal vascular endothelial growth factor (VEGF) products for
Independence commercial and Medicare Advantage members.* We will continue to
cover the other intravitreal VEGF products, but they will be approved only for
members who have demonstrated failure, contraindication, or intolerance to
Avastin or an Avastin biosimilar.
Currently, there are six intravitreal VEGF products that treat
ophthalmologic conditions such as neovascular (wet or exudative) advanced
macular degeneration and diabetic macular edema:
- Avastin® (bevacizumab)
- Eylea® (aflibercept)
- Lucentis® (ranibizumab)
- Macugen® (pegaptanib)
- Mvasi™ (bevacizumab-awwb)
- Zirabev™ (bevacizumab-bvzr)
Updates to VEGF precertification requirements
for ophthalmologic indications
Requests for intravitreal Avastin or its biosimilars
do not require
precertification approval from Independence.
All new requests for Eylea, Lucentis, or Macugen received on or after
January 1, 2020, will require precertification
approval for all Independence members.
Members who have received Eylea, Lucentis, or Macugen in the past 12 months
will continue to be approved to receive treatment with these drugs.
Learn more
In October, Independence will send letters to affected providers to notify
them of these changes.
Additional information about this change will be communicated in
future Partners in Health UpdateSM articles, and
our commercial and Medicare Advantage medical policies will be updated to
reflect these new requirements.
These changes will also be reflected in an updated precertification
requirement list, which will be posted to our website.
*As additional biosimilars to Avastin receive approval
from the U.S. Food and Drug Administration, these products will also be
designated as preferred products for Independence members.