Anthem: Susvimo Payer Policy

Created by C. Denise Burrell, Modified on Wed, 8 Jan at 2:32 PM by C. Denise Burrell

Anthem: Susvimo Payer Policy (Beta Access)

HCPCS Code(s):	J2779
Precertification Required?	Not Specified (Click Here for Full Policy)
Step Therapy Required?	Not Specified (Click Here for Full Policy)
Provider Fax Form:	(✅ Available in SamaCare)
FDA Approved Indications:	Neovascular (wet) age-related macular degeneration (AMD). Susvimo is intended for individuals who have responded to at least two anti-VEGF injections.
Recommended Dosage:	Implant Insertion: A one-time surgical procedure to place the Susvimo implant into the affected eye. Refills: The implant is designed to be refilled every 6 months (approximately every 24 weeks) to continuously deliver the medication.

Note: All indications for Susvimo are considered investigational and not medically necessary.

Other Pertinent Information

Susvimo utilizes an ocular implant for sustained release of ranibizumab.
The implant is refilled approximately every 6 months.
The policy includes a Black Box Warning regarding the risk of endophthalmitis and other implant-related adverse events.

Initial Approval Criteria

- Not Specified

Continuation Criteria

- Not Specified

Sources:

https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_e001584.html

https://www.susvimo.com

⚠️ Disclaimer: This article is a policy summary and does not guarantee coverage or approval.

Policies may vary based on plan, payer-specific rules, state or regional requirements, benefit structure, formulary placement, and patient-specific considerations like diagnosis or clinical history. Always review the full policy and confirm details directly with the payer to ensure compliance.

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