Ranibizumab Injections, Implants and Biosimilars

This policy covers ranibizumab injections, implants, and biosimilars for retinal and neovascular ocular conditions such as diabetic macular edema and diabetic retinopathy, macular edema from central or branch retinal vein occlusion, neovascular (wet) age‑related macular degeneration, nevascular glaucoma, rubeosis, and choroidal neovascularization (including myopic CNV). Coverage is limited to indications supported by peer‑reviewed literature or authoritative sources with dosing/frequency consistent with those sources, generally requires prior intravitreal bevacizumab failure or a documented contraindication/shortage to bevacizumab, mandates continuation only with documented benefit and appropriate dosing, and is subject to the member’s benefit contract and applicable state (Ohio) rules.

"Therapies are covered only when proven effective for the relevant diagnosis based on current peer‑reviewed scientific literature."