Avastin® and its biosimilars* (i.e., Alymsys®, Avzivi®, Mvasi®, Vegzelma®, Zirabev®) will continue to be the preferred (first line) VEGF products for Independence Blue Cross (IBX) Commercial and Medicare Advantage members.
Effective January 1, 2025, Lucentis® and its biosimilars* (i.e., Byooviz™, Cimerli®) will be second line preferred VEGF products for IBX Commercial and Medicare Advantage members. Members who are treatment naïve must try one of the Avastin or Avastin biosimilar products prior to moving to Lucentis or Lucentis biosimilars.
Vabysmo®, Beovu®, Eylea®, and Eylea® HD will be third line non-preferred VEGF products for IBX Commercial and Medicare Advantage members. Members must try one of the Lucentis or Lucentis biosimilar products prior to moving to Vabysmo, Beovu, Eylea, or Eylea HD.
We will continue to offer coverage for other VEGF products, but we will only approve those products for members who have demonstrated failure, contraindication, or intolerance to Avastin and/or Lucentis (or their respective biosimilars).
Updates to precertification requirements
Requests for intravitreal† Avastin or its biosimilars still will not require precertification approval from IBX.
Requests for Lucentis, Byooviz, Cimerli, Beovu, Vabysmo, Eylea, Eylea HD, or their biosimilars received on or after January 1, 2025, will still require precertification approval for all IBX members. Members who are currently receiving these drugs will be subject to a precertification review prior to their next treatment; these members will not be required to transition to a new product. New first/second/third line protocols only impact new start patients.
When Eylea biosimilars are approved by the FDA, requests for these drugs will require precertification approval for all IBX members.
Learn more
These changes will be reflected in updated Commercial and Medicare Advantage medical policies in January 2025:
- Commercial:
- #08.00.74: Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors.
- Medicare Advantage:
- #MA08.073: Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors.
To view any pending policy notifications (which signify upcoming changes) or active medical policies, you can visit the IBX Medical and Claim Payment Policy Portal.
Under Active Notifications or Policy Bulletins, select Commercial or Medicare Advantage, based on which version of the policy you want to view. Then, you can search by category, or type the policy name or number in the Search box up top. For more information on accessing medical policies, refer to our article on Staying updated on Medical Policies.
* As additional biosimilars to Avastin and Lucentis receive FDA approval, these products will also be designated as preferred and second line preferred products for IBX members.
† When prescribed as part of a cancer treatment regimen, all requests for Avastin or its biosimilars require precertification approval from IBX.