As previously communicated in a Partners in Health Update^SM article, as of January 1, 2020,Avastin^® and its biosimilars (i.e., Mvasi™, Zirabev™) are 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 requireprecertification approval from Independence.

All new requests for Eylea, Lucentis, or Macugen received on or after January 1, 2020, 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

The following commercial and Medicare Advantage medical policies have been updated to reflect the new step therapy criteria:

• Commercial: #08.00.74m: Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and related biosimilars
• Medicare Advantage: #MA08.073f: Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and related biosimilars

These changes are reflected in an updated precertification requirement list, which is posted on 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.