Payer PolicyActive
Faricimab-svoa (Vabysmo™)
EVICORE-MEDICAL_DRUG-5D30D02B
EviCore by Evernorth
Effective: June 1, 2022
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Vabysmo (faricimab‑svoa) is covered only for FDA‑approved indications—neovascular (wet) AMD and diabetic macular edema—with approvals up to 12 months and dosing limited to 6 mg intravitreal: for nAMD, no more frequently than every 4 weeks for four doses then no more frequently than every 8 weeks; for DME, no more frequently than every 4 weeks. Coverage requires documentation of the FDA‑approved diagnosis, adherence to the specified dosing schedule, and administration by or under the supervision of an ophthalmologist.
Coverage Criteria Preview
Key requirements from the full policy
"Neovascular (wet) age-related macular degeneration (nAMD)"
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