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DrugSusvimo™ (ranibizumab) [Genentech, Inc.]

April 2022

Therapeutic Area - Macular Degeneration Agents

Initial approval criteria

  • Patient is at least 18 years of age AND 

Universal Criteria

  • Patient is free of ocular and/or peri-ocular infections AND 
  • Patient does not have active ocular inflammation AND 
  • Therapy will not be used with other ophthalmic VEGF inhibitors (e.g., aflibercept, pegaptanib, brolucizumab, bevacizumab, ranibizumab) unless supplemental treatment is necessary (find more information in renewal criteria) AND 
  • Patient has not required removal of a Susvimo implant in the past AND 
  • Patient does not have a hypersensitivity to other ranibizumab products (i.e., Lucentis®, Byooviz™, etc.) AND 
  • Patient’s best corrected visual acuity (BCVA) is measured at baseline and periodically during treatment AND

Neovascular (Wet) Age-Related Macular Degeneration (AMD) 

  • Patient has previously responded to at least two intravitreal injections of a vascular endothelial growth factor (VEGF) inhibitor medication (e.g., aflibercept, pegaptanib, brolucizumab, bevacizumab, ranibizumab)
  • Initial approval is for 6 months

Renewal criteria

  • Patient continues to meet the universal and indication-specific relevant criteria as identified in the initial approval criteria AND 
  • Absence of unacceptable toxicity from the drug. Examples of unacceptable toxicity include the following: endophthalmitis, rhegmatogenous retinal detachment, implant dislocation, vitreous hemorrhage, conjunctival erosion, conjunctival retraction, and conjunctival blebs, 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 AND 
  • Supplemental treatment only: Patient has had an insufficient response during initial or maintenance therapy with Susvimo administered every 24 weeks and requires supplemental treatment with intravitreal ranibizumab
  • Renewal approval is for 6 months

Quantity limits

  • 2 mg (0.02 mL of 100 mg/mL solution) continuously delivered via the Susvimo ocular implant with refills administered every 24 weeks (approximately 6 months) 


  • Supplemental treatment with 0.5 mg (0.05 mL of 10 mg/mL) intravitreal ranibizumab injection may be administered in the affected eye while the Susvimo implant is in place and if clinically necessary

Billing for Susvimo

  • Susvimo must be billed as a medical claim


MHCP Provider Resource Center 651-431-2700 or 1-800-366-5411

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