JUL 08, 2021
United Healthcare Implements New Policy That Limits Use of Anti-VEGF Drugs
The Academy is aware of United Healthcare’s (UHC) new policy on vascular endothelial growth factor (VEGF) inhibitors. UHC commercial plans’ updated medical policy for anti-VEGF drugs, which went into effect July 1, will limit the use of the following drugs to nine times a year per eye: Avastin, Beovu, Eylea, Lucentis, Macugen, Mvasi and Zirabev.
There are serious risks to imposing one standard for a broad host of blinding retina conditions. In addition, the UHC policy is contrary to the U.S. Food and Drug Administration’s approved dosing frequencies and labeling.
The policy is for commercial lines of business only, and there is no clear process for exceptions at this time.
The Academy has scheduled a meeting with UHC to share our concerns over these limitations and to discuss the appropriateness of this policy. We will provide you with updates as we get more information.