CommercialPrior AuthMedium impact
Faricimab-svoa (Vabysmo™)
BCBS Tennessee·TN · Ophthalmology·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee is implementing a new medical policy for Faricimab-svoa (Vabysmo™) effective December 1, 2026. The policy covers three FDA-approved indications (diabetic macular edema, neovascular wet age-related macular degeneration, and macular edema following retinal vein occlusion) with 12-month authorization periods and requires step therapy. This is a future-dated policy requiring advance preparation for implementation.
Action Required
By November 1, 2026: Billing and prior authorization teams must prepare systems for the Vabysmo™ policy implementation. (1) Review the Step Therapy Requirements document at https://www.bcbst.com/docs/providers/Comm_BC_PAD_Step_Therapy_Guide.pdf to understand mandatory step therapy prerequisites before claims can be approved. (2) Update billing software to require prior authorization for all Vabysmo™ claims with 12-month authorization periods for the three covered indications. (3) Configure system to limit prescribers to ophthalmologists or consultations with ophthalmologists only. (4) Train front-desk and authorization staff on the three covered indications and step therapy requirements. (5) Ensure denial logic for experimental/investigational uses (off-label indications not meeting Tennessee state mandate criteria). Claims submitted without proper step therapy completion and authorization will be denied.