Ranibizumab Implant (Susvimo®)

Susvimo (ranibizumab implant) is generally not recommended for approval/coverage by this payer due to safety concerns (boxed warning for endophthalmitis), despite FDA approval for neovascular (wet) AMD in patients who previously responded to at least two intravitreal VEGF injections. Coverage would require documentation of the AMD diagnosis, evidence of response to ≥2 prior intravitreal VEGF inhibitor injections (dates, drugs, clinical response), and adherence to any additional unspecified coverage guidelines.

"Patient must be diagnosed with an FDA-approved indication."

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