Ranibizumab (Lucentis)

Lucentis (ranibizumab) is covered only for the listed FDA-approved indications (neovascular AMD, macular edema from RVO, DME, DR, myopic CNV) and the specified compendial off‑label uses (neovascular glaucoma, retinopathy of prematurity, sickle cell neovascularization, choroidal neovascular conditions); other indications are excluded. Approval is for 12 months and requires administration by or under an ophthalmologist, documentation of the listed diagnosis and medical necessity, and adherence to indication‑specific dosing/frequency per policy (e.g., 0.5 mg intravitreal q4w for AMD/RVO and up to 0.5 mg q4w for off‑label uses; 0.3 mg q4w for DME/DR; mCNV per policy dosing).

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

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