Izervay (avacincaptad pegol intravitreal injection)

Izervay (avacincaptad pegol intravitreal) is covered only for the FDA‑approved indication of geographic atrophy secondary to age‑related macular degeneration and is not covered for other uses. Key requirements: BCVA in the affected eye 20/25–20/320, administration by or under an ophthalmologist, dosing 2 mg (0.1 mL of 20 mg/mL) intravitreal monthly for up to 12 months (approval limited to 12 months), and documentation of diagnosis, BCVA, provider administration, and treatment plan per the policy.

"Treatment of geographic atrophy secondary to age-related macular degeneration (AMD) (FDA‑approved indication)."

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