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

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

Vabysmo must be billed as a medical claim

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