Vabysmo™
Drug - Vabysmo™ (faricimab-svoa) [Genentech, Inc.]
October 2022
Therapeutic area - Macular Degeneration Agents
Initial approval criteria
- Patient is at least 18 years of age AND
- Patient is free of ocular and/or peri-ocular infections AND
- Patient does not have active intraocular inflammation AND
- Therapy will not be used with other ophthalmic VEGF inhibitors (e.g., aflibercept, brolucizumab-dbll, ranibizumab, pegaptanib, bevacizumab, etc.) AND
- Patient’s best corrected visual acuity (BCVA) is measured at baseline and periodically during treatment AND
- Vabysmo will be prescribed by an ophthalmologist AND
- Patient has a definitive diagnosis of one of the following:
- Neovascular (Wet) Age-Related Macular Degeneration (nAMD)
- Diabetic Macular Edema (DME)
- Prescriber attests that the patient will be assessed regularly and continued administration of Vabysmo will be at the frequency consistent with FDA-approved label
Renewal criteria
- Patient continues to meet the initial approval criteria AND
- Absence of unacceptable toxicity from the drug. Examples of unacceptable toxicity include the following: endophthalmitis and retinal detachments, increase in intraocular pressure, arterial thromboembolic events (ATE), etc. AND
- Patient has had a beneficial response to therapy (e.g., improvement in the baseline best corrected visual acuity (BCVA), etc.) and continued administration is necessary for the maintenance treatment of the condition
Quantity limits
Billing for Vabysmo
Vabysmo must be billed as a medical claim
Questions?
MHCP Provider Resource Center 651-431-2700 or 800-366-5411