Effective September 18, 2023, Independence Blue Cross and Independence Administrators will update their medical policy on Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) inhibitors for Commercial and Medicare Advantage 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 its 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. It is represented by HCPCS code J2503 Injection, pegaptanib sodium, 0.3 mg, whose coverage is Not Eligible for Reimbursement.
For Medicare Advantage members, due to the retired Novitas LCA, the following criterion was removed from Eylea, bevacizumab, Beovu®, and Lucentis: "Other retinal diseases, including ischemic retinal vein occlusions, and for decreasing the vascularity of proliferative diabetic retinopathy prior to vitreous surgery." These indications are covered under indications from the FDA labeling.
For more information, please view the following notifications that were published on June 20, 2023: