MedicaidPrior AuthMedium impact
Vabysmo® (faricimab-svoa) (New)
Humana·OH · Ophthalmology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Vabysmo (faricimab-svoa) intravitreal injections for Ohio Medicaid patients with wet AMD, diabetic macular edema, or retinal vein occlusion. Prior authorization requires documented contraindication, intolerance, or lack of response to bevacizumab before approval.
Action Required
Before October 22, 2025: Billing team must implement prior authorization requirements for Vabysmo (faricimab-svoa) intravitreal injections for Ohio Medicaid patients. Providers must document contraindication, intolerance, or lack of response to bevacizumab before prescribing. Update system to flag these cases for prior auth submission. Claims will be denied without proper authorization.