Description: Inj, faricimab-svoa, 0.1mg
Unit: 0.1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 6mg IVT every 1 month for the first 4 doses
Based on evaluations 8-12 weeks later, administer 6mg IVT on one of the following regimens:
• weeks 28 and 44
• weeks 24, 36, and 48
• weeks 20, 28, 36, and 44
• 6mg IVT every 1 month for at least 4 doses
Based on resolution of edema after 4 doses, frequency may be increased or decreased
• 6mg IVT every 1 month for the first 6 doses
• 6mg IVT every 2 months
Calculate drug reimbursement
(ASP: $2,070.17, Margin: $124.21)
# Units to bill:60
Prior auth criteria for Vabysmo may include but is not limited to:
1. Patient must have a diagnosis of wet age-related macular degeneration (AMD).
2. Treatment must be initiated within 6 months of diagnosis.
3. The patient must not have received prior therapy for wet AMD.
4. The patient must be at least 18 years of age.
5. The patient must have adequate ocular media clarity to visualize the lesion and macula.
6. The patient must have best-corrected visual acuity of 20/50 or worse in the affected eye.
7. The patient must have a macular lesion length of less than 12 mm.
8. The patient must have a total lesion area of less than 12 disc areas (DA).
Insurance prior auth guidelines:
Vabysmo (GENENTECH USA, INC.)