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Highmark Announces Ophthalmologists No Longer Need Prior Authorization for Intravitreal Avastin

On Nov. 24, 2014, Highmark announced some good news for ophthalmologists. Effective immediately, ophthalmologists will no longer need to enter a prior authorization for the use of intravitreal Avastin in order for claims to be paid.

The Pennsylvania Medical Society (PAMED), Pennsylvania Academy of Ophthalmology (PAO), and Allegheny County Medical Society (ACMS) previously communicated physician concerns to Highmark, including that the prior authorization requirement was burdensome, futile, and just wastes time.

At the time, Highmark assured us that it was working on a solution, but due to the problem being technical in nature, it had no simple fix. PAMED, PAO, and ACMS continued to stay in communication with Highmark and express physician concerns, and are happy to let ophthalmologists know of this recent victory.

“We want to thank you for your support and patience as we completed the work necessary to bring this important request to fruition,” said Highmark in an email to PAMED and other stakeholders. “We also want to thank the ophthalmology community for their patience, and their willingness to complete the prior authorization requirement for Avastin while this work was being completed, as this prevented member claims from being denied.”

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