Payer PolicyActive
Susvimo® (ranibizumab intravitreal injection via ocular implant)
EVICORE-MEDICAL_DRUG-121B6844
EviCore by Evernorth
Effective: February 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Susvimo is indicated for neovascular (wet) AMD in patients who previously responded to at least two intravitreal VEGF injections, but this policy does not recommend approval due to significant safety concerns, including a boxed warning for endophthalmitis. Coverage is limited to patients meeting the FDA indication and prior‑treatment requirement; no specific documentation requirements or effective date are provided.
Coverage Criteria Preview
Key requirements from the full policy
"Susvimo is indicated for the treatment of patients with Neovascular (wet) Age-related Macular Degeneration (AMD) who have previously responded to at least two intravitreal injections of a Vascular ..."
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