Intravitreal, Punctum, and Intracameral Implants

This policy covers coverage criteria for intravitreal, punctum, and intracameral drug implants (e.g., Retisert, Iluvien/Yutiq, Dextenza, Durysta) used to deliver corticosteroids or IOP‑lowering agents for conditions such as chronic noninfectious posterior uveitis, diabetic macular edema, macular edema from retinal vein occlusion, radiation retinopathy, prophylaxis of cystoid macular edema, postoperative ocular inflammation/pain, allergic conjunctivitis, and open‑angle glaucoma/ocular hypertension. Coverage is limited to FDA‑approved indications and authoritative dosing guidance, requires specific patient criteria (e.g., Retisert ≥12 years, Iluvien only in adults with prior steroid tolerance, Durysta only after trial/failure or intolerance to ≥2 IOP‑lowering drops including a prostaglandin), and excludes use in active ocular/periocular infections, advanced glaucoma (cup‑to‑disc >0.8) and other uses deemed experimental; benefit plan and state regulations govern final coverage.