Ranibizumab (Lucentis®, Byooviz™, and Cimerli™) Injection
EVICORE-MEDICAL_DRUG-5331BAFA
Ranibizumab (Lucentis, Byooviz, Cimerli) is covered for FDA‑approved indications (neovascular/wet AMD, RVO‑related macular edema, DME, DR, mCNV) and compendial neovascular ophthalmic uses, and other uses are not covered unless supported by compendia. Approval is for up to 12 months, must be administered by or under an ophthalmologist, and dosing/frequency limits apply by indication (0.5 mg IV monthly for AMD/RVO/other neovascular diseases; 0.3 mg IV monthly for DME/DR; mCNV 0.5 mg IV monthly for up to 3 months), with documentation limited to diagnosis and meeting the coverage guidelines.
"Neovascular (wet) age-related macular degeneration (AMD)"
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