Ranibizumab (Lucentis®, Byooviz™, and Cimerli™) Injection

Ranibizumab (Lucentis, Byooviz, Cimerli) is covered for FDA‑approved indications (neovascular AMD, RVO‑related macular edema, DME, DR, mCNV) and select compendial off‑label neovascular ophthalmic uses; other uses without compendial support are excluded. Coverage requires a qualifying diagnosis, administration by/under an ophthalmologist with documentation of intravitreal dosing consistent with the policy (0.5 mg monthly for AMD/RVO/most neovascular diseases, 0.3 mg monthly for DME/DR, 0.5 mg monthly up to 3 months for mCNV with retreatment as needed), compendial citation for off‑label uses, and approvals are valid for 12 months.

"Neovascular (wet) age-related macular degeneration (AMD)"

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