Intracanalicular and Intravitreal Corticosteroid Implants – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers specific intracanalicular and intravitreal corticosteroid implants — Dextenza for post‑operative ocular inflammation/pain and allergic conjunctival itching; Iluvien, Ozurdex, Retisert, and Yutiq for chronic non‑infectious posterior uveitis (Iluvien and Ozurdex also for DME, Ozurdex for RVO‑related macular edema) — and considers other uses (e.g., cystoid macular edema after cataract surgery, radiation retinopathy) unproven/not medically necessary. Coverage requires product‑specific criteria (e.g., Iluvien: prior corticosteroid course with no clinically significant IOP rise; Dextenza: prescribed by or in consultation with an ophthalmologist), documentation of diagnosis and laterality, a one‑implant/insert per eye dose limit, authorizations ≤60 days, and any additional member‑specific benefit/mandate requirements.

"Ozurdex (dexamethasone intravitreal implant): Diabetic macular edema (DME)."