Avacincaptad pegol

This policy covers intravitreal avacincaptad pegol (Izervay) for treatment of geographic atrophy (GA) secondary to age‑related macular degeneration (AMD) to slow GA lesion growth, with diagnosis confirmed by GA‑sensitive testing. Coverage is limited to FDA‑approved dosing/administration (2 mg intravitreal ≈ every 28 ± 7 days) and up to 12 months authorization, must be prescribed by or in consultation with an ophthalmologist experienced in retinal disease, and non‑FDA indications or extended dosing are considered investigational unless supported by HHS‑adopted compendia or two peer‑reviewed articles; member benefit plans and state rules govern specific caps and exclusions.

"Coverage decisions are made consistent with available clinical evidence, relevant professional society guidelines, and CMS coverage policy."

Sign up to see full coverage criteria, indications, and limitations.