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DrugVabysmo™ (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

  • 6 mg every 28 days

Billing for Vabysmo

Vabysmo must be billed as a medical claim 


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

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