Your Medicaid Plan Doesn’t List Luminopia — But Federal Law Is on Your Side

UHC Community Plan - North Carolina (Medicaid) hasn’t published a coverage policy for Luminopia. The good news: under federal Medicaid law, your child has a right to medically necessary care through a benefit called EPSDT. Our team will help you and your doctor pursue coverage on that basis.

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What is EPSDT?

EPSDT stands for Early and Periodic Screening, Diagnostic, and Treatment. It’s a federal Medicaid benefit that requires state Medicaid programs to cover any service that is medically necessary to “correct or ameliorate” a health condition for members under age 21 — even if that service isn’t already on the state’s standard list of covered benefits. EPSDT is a legal pathway used to pursue coverage when a Medicaid plan hasn’t added Luminopia as a covered treatment.

How We Pursue Coverage Together

Step 1 — Talk to Your Doctor About Luminopia

Ask your child’s eye doctor if Luminopia is right for them. If your doctor is unfamiliar with prescribing Luminopia, they can visit the Healthcare Professional tab on our website for additional information.
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If you are looking for a provider near you already familiar with Luminopia:

FIND A PRESCRIBER NEAR YOU

Step 2 — We Submit an EPSDT-Based Coverage Request

Once your doctor writes a prescription, our team works with their office to submit an EPSDT-based prior authorization to UHC Community Plan - North Carolina (Medicaid).

Step 3 — We Keep You Updated Through the Decision

Pentec Health, our medical-benefits partner, manages the EPSDT submission and any follow-up the plan requests. You’ll receive secure text updates throughout the process. If UHC Community Plan - North Carolina (Medicaid) initially denies the request, our team can support an appeal. EPSDT decisions are frequently overturned on appeal when medical necessity is well-documented.

What if Medicaid still won’t cover Luminopia?

We don’t want coverage to stand between your child and treatment. If the EPSDT pathway is unsuccessful, the Luminopia Patient Access Program can still help your family access therapy.

Supporting Every Patient, Every Step of the Way

Prescription Status Assistance

If you haven’t received a text from CoAssist confirming your prescription — or a request for additional information — within 3 business days, you can contact CoAssist directly to check on your prescription status at (855) 382-2533.

Concerned About Cost?

We’ve got you covered, whether your plan covers Luminopia (for your child) or not. We’re committed to ensuring every patient prescribed Luminopia can access therapy. If you’re concerned about cost, Luminopia access programs may be able to help.

Additional Questions? More Info Here

Luminopia: Directions For Use, LBL-0001 Rev E. Luminopia, Inc; 2025.
Xiao, S., Angjeli, E., Wu, H. C., Gaier, E. D., Gomez, S., Travers, D. A., Binenbaum, G., Langer, R., Hunter, D. G., Repka, M. X., & Luminopia Pivotal Trial Group (2022). Randomized Controlled Trial of a Dichoptic Digital Therapeutic for Amblyopia. Ophthalmology, 129(1), 77–85. https://doi.org/10.1016/j.ophtha.2021.09.001.
Data on file, 2023. Luminopia, Inc.
Li, J., Thompson, B., Lam, C. S., Deng, D., Chan, L. Y., Maehara, G., Woo, G. C., Yu, M., & Hess, R. F. (2011). The role of suppression in amblyopia. Investigative ophthalmology & visual science, 52(7), 4169–4176. https://doi.org/10.1167/iovs.11-7233
Birch, E. E., Jost, R. M., Wang, Y. Z., Kelly, K. R., & Giaschi, D. E. (2019). Impaired Fellow Eye Motion Perception and Abnormal Binocular Function. Investigative ophthalmology & visual science, 60(10), 3374–3380. https://doi.org/10.1167/iovs.19-26885
Wallace, M. P., Stewart, C. E., Moseley, M. J., Stephens, D. A., Fielder, A. R., Monitored Occlusion Treatment Amblyopia Study (MOTAS) Cooperatives, & Randomized Occlusion Treatment Amblyopia Study (ROTAS) Cooperatives (2013). Compliance with occlusion therapy for childhood amblyopia. Investigative ophthalmology & visual science, 54(9), 6158–6166. https://doi.org/10.1167/iovs.13-11861

Link to Healthcare Professionals Site

The information contained in this section is intended for U.S. healthcare professionals only.