Health Net
Eylea (aflibercept)
Drugs for the Eye : Drugs for the Eye
  • Step Therapy: Diabetic Retinopathy, Macular Edema Following Retinal Vein Occlusion (RVO):
    ST Single Brand

    Macular Edema, Neovascular (Wet) Age-Related Macular Degeneration (AMD):
    ST Single Generic

  • Diabetic Retinopathy, Macular Edema Following Retinal Vein Occlusion (RVO), Neovascular (Wet) Age-Related Macular Degeneration (AMD):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Ophthalmologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

    Macular Edema:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Ophthalmologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

  • Prior Authorization: Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

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