Susvimo® (Ranibizumab Injection) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Susvimo (ranibizumab intravitreal implant) only for neovascular (wet) AMD, diabetic macular edema (DME), and diabetic retinopathy (DR) and does not cover other indications absent a state mandate or member-specific benefit requiring otherwise. Coverage requires prior documented response to at least two intravitreal VEGF inhibitor injections, dosing per FDA labeling, initial and reauthorization approvals limited to ≤12 months, and reauthorization requires documentation of a positive clinical response; member-specific benefit documents govern final coverage and FDA approval alone is not sufficient.

"Documentation that dosing is in accordance with the United States Food and Drug Administration approved labeling."

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