MedicaidPrior AuthMedium impact
Vabysmo_(faricimab-svoa)_
Humana·IN · Ophthalmology, Endocrinology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Vabysmo (faricimab-svoa) intravitreal injections effective December 1, 2025. The policy requires prior auth for all three FDA-approved indications (wet AMD, diabetic macular edema, and macular edema from retinal vein occlusion) and mandates that patients must have contraindications to or failed therapy with bevacizumab before approval.
Action Required
By December 1, 2025: Billing and clinical staff must implement prior authorization requirements for all Vabysmo (faricimab-svoa) intravitreal injections for Humana Indiana Medicaid patients. Update billing system to flag these cases for prior auth. Providers must document patient diagnosis (wet AMD, diabetic macular edema, or RVO macular edema) and evidence of bevacizumab contraindication, intolerance, or treatment failure with attestation of lack of clinical response. Claims will be denied without proper prior authorization.