Vascular Endothelial Growth Factor Inhibitors for Ocular Indications

Covered: Aetna authorizes VEGF inhibitors (e.g., aflibercept, bevacizumab and biosimilars, ranibizumab products, brolucizumab, faricimab, pegaptanib) for diabetic macular edema, diabetic retinopathy (limited agents), macular edema from retinal vein occlusion, neovascular AMD, and retinopathy of prematurity, while all other ocular indications are considered experimental/investigational. Key requirements/limits: specific biosimilars/brands (Byooviz/Cimerli) are only covered after contraindication/intolerance/ineffective response to Avastin, many branded agents require failure or intolerance to Avastin and Byooviz/Cimerli before use, VEGF inhibitors are contraindicated in endophthalmitis or ocular/periocular infection, and concurrent use of more than one VEGF inhibitor in the same eye is not covered (experimental).

"Macular edema following cataract surgery (refractory pseudophakic CME)"