MedicaidPrior AuthMedium impact
Vabysmo® (faricimab-svoa) (New)
Humana·OH · Ophthalmology, Endocrinology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid in Ohio has implemented a new prior authorization policy for Vabysmo® (faricimab-svoa) intravitreal injections used to treat wet AMD, diabetic macular edema, and macular edema following retinal vein occlusion. Prior authorization is required for all uses, with approval only granted if patients have contraindications to or failed bevacizumab therapy.
Action Required
Before October 22, 2025: Billing team must update prior authorization requirements for Vabysmo® (faricimab-svoa) intravitreal injections for Ohio Medicaid patients. Providers must document contraindications or treatment failure with bevacizumab before prescribing. Update EMR templates to include required clinical documentation for wet AMD, diabetic macular edema, and retinal vein occlusion cases. Claims will be denied without proper prior authorization.