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BCBS TennesseeCommercial · Prior Auth · Medical Policy · TN · OphthalmologyMedium impact

Faricimab-svoa (Vabysmo™)

Act
by Nov 1, 2026
Effective date
Dec 1, 2026
Identified
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.

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What to do

by Nov 1, 2026 · 7 steps
01Billing and prior authorization teams must prepare systems for the Vabysmo™ policy implementation.
02Review 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.
03Update billing software to require prior authorization for all Vabysmo™ claims with 12-month authorization periods for the three covered indications.
04Configure system to limit prescribers to ophthalmologists or consultations with ophthalmologists only.
05Train front-desk and authorization staff on the three covered indications and step therapy requirements.
06Ensure denial logic for experimental/investigational uses (off-label indications not meeting Tennessee state mandate criteria).
07Claims submitted without proper step therapy completion and authorization will be denied.

Original notice

Faricimab-svoa (Vabysmo™)
bcbst.com · Always check the source before changing claims.
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BCBS Tennessee policiesTN policy changesOphthalmology

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