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Number: 0701 Aetna considers pegaptanib na injection (Macugen) medically necessary for the treatment of individuals with neovascular (wet) age-related macular degeneration (AMD) and diabetic macular edema. Aetna considers pegaptanib metallic element injection experimental and investigational for the treatment of the undermentioned indications (not an all-inclusive list) because its effectualness for these indications has not been established: Aetna considers intravitreal ranibizumab and bevacizumab injections observational and investigational for care of the following indications (not an all-inclusive list) because their effectualness for these indications has not been established. Aetna considers topical administration, subconjunctival or intrastromal injections of ranibizumab or bevacizumab for the treatment of corneal neovascularization empiric and investigational because their effectualness for this communication has not been established.
Vascular Endothelial Growth Factor Inhibitors for Ocular Indications - Medical Clinical Policy Bulletins | Aetna
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