Ophthalmology - Luxturna™

Covers one-time bilateral Luxturna treatment (one 1.5 × 10^11 vg/0.3 mL subretinal injection per eye) for genetically confirmed biallelic RPE65 mutation–associated retinal dystrophy in patients ≥12 months and <65 years with viable retinal cells, and excludes re‑treatment of previously treated eyes and use in patients <12 months or ≥65 years. Key requirements: administration by a retinal specialist, injections separated by ≥6 days, and documentation of genetic test results, age, retinal viability, dosing/administration and supporting chart notes/labs.

"Patient is not receiving re-treatment of eye(s) previously treated with Luxturna."

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