Health Net
Lucentis (ranibizumab)
Drugs for the Eye : Drugs for the Eye
  • Diabetic Retinopathy, Macular Edema, 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)

    Myopic Choroidal Neovascularization (mCNV):
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Ophthalmologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 3 month(s)

  • Step Therapy: ST Single Generic

  • Prior Authorization: Diabetic Retinopathy, Macular Edema, Macular Edema Following Retinal Vein Occlusion (RVO), Neovascular (Wet) Age-Related Macular Degeneration (AMD):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Myopic Choroidal Neovascularization (mCNV):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Reauthorization Required: Yes

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