Payer PolicyActive
Susvimo® (ranibizumab intravitreal injection via ocular implant)
EVICORE-MEDICAL_DRUG-51BEB50A
EviCore by Evernorth
Effective: January 1, 2026
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Susvimo is not recommended for approval/coverage despite its FDA indication for neovascular (wet) AMD, and use is discouraged because of significant safety concerns including a boxed warning for endophthalmitis; non‑FDA indications are not supported. The only stated requirement is prior documented response to at least two intravitreal VEGF inhibitor injections per the FDA indication, and no additional documentation requirements are specified.
Coverage Criteria Preview
Key requirements from the full policy
"Treatment of patients with Neovascular (wet) Age-related Macular Degeneration (AMD) who have previously responded to at least two intravitreal injections of a Vascular Endothelial Growth Factor (VE..."
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