Aimed Alliance Raising Issues with BSBC of Alabama’s Prior Authorization Policy for Treatment of Degenerative Eye Diseases

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On July 2, 2021, Aimed Alliance sent a letter to Blue Cross Blue Shield of Alabama (BCBS AL) in response to a new prior authorization policy, effective July 1, 2021, for a medication to treat degenerative eye diseases.[1] The policy requires patients with neovascular (wet) age-related macular degeneration (Wet AMD), macular edema following retinal vein occlusion (MEfRVO), diabetic macular edema (DME), and diabetic retinopathy (DR) to try and fail on an off-label, compounded medication before accessing a medication that is FDA approved for such conditions. If a medication to treat these eye conditions is ineffective, patients can experience rapid and severe loss of central vision.[2] Therefore, Aimed Alliance recommended that BCBS AL amend its prior authorization policy to remove the step therapy requirements for patients with Wet AMD, MEfRVO, DME, and DR. Read the letter here.

 

[1] https://al-policies.exploremyplan.com/portal/web/medical-policies/-/ph-90026?print=1
[2] https://visionaware.org/your-eye-condition/age-related-macular-degeneration-amd/treatments-for-wet-macular-degeneration/#:~:text=In%20wet%20(neovascular%2Fexudative),severe%20loss%20of%20central%20vision

 

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