| 694 | For the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) in a treatment-naive eye.
Initial diagnosis should be confirmed by an appropriate diagnostic procedure and administration should be done by a qualified ophthalmologist experienced in intravitreal injections.
Patients receiving concurrent administration of other anti-VEGF intravitreal injections are not eligible for reimbursement.
Treatment with anti-VEGF agents should only be continued in patients who maintain adequate response to therapy.
Coverage will be provided for patients responding to therapy with another anti-VEGF agent who switch to Eylea HD. Coverage will not be provided for patients who have failed to respond to other anti-VEGF agents.
Recommended Dose: Treatment should be initiated with a monthly intravitreal injection for the first 3 consecutive doses, followed by one injection every 8 to 16 weeks.
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| | LU Authorization Period: 1 year |
| 695 | For the treatment of patients with clinically significant diabetic macular edema (DME) for whom laser photocoagulation is also indicated; and a hemoglobin A1c of less than 12 percent.
Patients receiving concurrent administration of other anti-VEGF intravitreal injections are not eligible for reimbursement.
Treatment with anti-VEGF agents should only be continued in patients who maintain adequate response to therapy.
Coverage will be provided for patients responding to therapy with another anti-VEGF agent who switch to Eylea HD. Coverage will not be provided for patients who have failed to respond to other anti-VEGF agents.
Recommended Dose: Treatment should be initiated with a monthly intravitreal injection for the first 3 consecutive doses, followed by one injection every 8 to 16 weeks.
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| | LU Authorization Period: 1 year |
