Avico automates benefits checks, prior authorization, step-therapy research, and denial follow-up for anti-VEGF and geographic atrophy treatments—so fewer injections get stuck before the next appointment.
Book a DemoPrior authorization and step-therapy requirements differ across payors, plans, indications, and therapies. Staff must keep pace with changing rules while protecting a high-volume injection schedule and the practice's buy-and-bill investment.
Many plans require prior authorization for anti-VEGF and other intravitreal injections, while preferred-drug and step-therapy rules vary by plan. Across a packed injection schedule, the volume builds faster than coordinators can stay ahead of.
Requirements can change by drug, diagnosis, plan, and line of business. Missing a required treatment history, chart note, or step edit can turn an Eylea, Eylea HD, or Vabysmo request into a denial and another round of follow-up.
Retina practices purchase costly buy-and-bill drugs before reimbursement. A missed authorization, expired approval, or unsupported drug switch can put thousands of dollars at risk while the patient waits for treatment.
Avico's AI agents execute the work required before each injection—verifying coverage, securing approval, and calculating patient responsibility in the right order.
Avico verifies coverage, active authorization dates, plan limits, and buy-and-bill versus specialty pharmacy routing before each injection, drug change, or plan reset.
Avico checks current payor requirements, pairs the patient's diagnosis and treatment history with the right chart evidence, submits through the required channel, and tracks the case to determination.
Avico calculates expected patient responsibility and flags patients who may qualify for copay cards or foundation support before treatment is delayed.
Avico applies the patient's current plan requirements to the therapy the physician selected. Coverage criteria and preferred products can change, so every case is checked against the applicable policy rather than a universal rule.
For Eylea, Eylea HD, Vabysmo, and biosimilars, Avico checks the patient's current plan for prior authorization, preferred-product, and step-therapy requirements. It prepares the request with the diagnosis, treatment history, response, and supporting chart evidence the plan requests.
For Syfovre and Izervay, Avico identifies plan-specific medical-necessity and preferred-product criteria, gathers the relevant diagnosis and imaging documentation, and monitors authorization and reauthorization dates.
When a physician changes therapy or an existing approval approaches expiration, Avico rechecks the policy, documents prior treatment and clinical rationale, and starts the next authorization before it disrupts the injection schedule.
Avico catches missing chart evidence, unmet step edits, coverage changes, and submission errors before the request goes out. If a payor still denies the request, the team can see the reason and the next required action without starting the research over.
Retina practices carry the financial risk for high-cost, low-margin buy-and-bill drugs. Avico's AI agents complete routine payor work before each injection, helping teams prevent missed authorizations and avoid unreimbursed treatments.
Book a demo to see how Avico manages intravitreal injection authorizations across your schedule.
Book a Demo