Effective September 18, 2023, the AmeriHealth companies (collectively known as AmeriHealth) and AmeriHealth Administrators will update their medical policies on Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) inhibitors for Commercial members.
This policy has been updated to communicate the Company's coverage position for the newly FDA-approved products, faricimab-svoa (Vabysmo®) and intravitreal ocular implant ranibizumab (SusvimoTM).
The policy clarifies that bevacizumab is the preferred product for members who are treatment-naïve.
Aflibercept (Eylea®), bevacizumab (Avastin®), and ranibizumab (Lucentis®) and related biosimilars are covered for the new indication of retinopathy of prematurity.
Continuation Therapy criteria was added as a policy criterion.
The following HCPCS codes have been added to this policy:
- J2777 Injection, faricimab-svoa, 0.1 mg
- J2779 Injection, ranibizumab, via intravitreal implant (Susvimo), 0.1 mg
Pegaptanib sodium (Macugen®) was removed from this policy since it is no longer manufactured and has been withdrawn from market. It is represented by HCPCS code J2503 Injection, pegaptanib sodium, 0.3 mg, whose coverage is Not Eligible for Reimbursement.
For more information, please view #08.00.74s: Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) inhibitors, which was published as a notification on June 20, 2023.