Product Details

Vabysmo

Faricimab
6 mg/0.05 mL
Solution for Intravitreal Injection
0.24-mL Single-Use Glass Vial (Preservative-Free)

DIN/PIN/NPN

02527618

Manufacturer

Hoffmann-La Roche Limited

Formulary Listing Date

2023-06-30  

Unit Price

1350.0000

Amount MOH Pays

1350.0000

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01LA09

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
649 1 year

For the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) in a treatment-naive eye.

Initial diagnosis should be confirmed by an appropriate diagnostic procedure and administration should be done by a qualified ophthalmologist experienced in intravitreal injections.

Patients receiving concurrent administration of verteporfin PDT (Visudyne), ranibizumab (Lucentis), aflibercept (Eylea) or brolucizumab (Beovu) are not eligible for reimbursement.

Treatment should be initiated with an intravitreal injection every 4 weeks for the first 4 doses, followed by one injection every 8 to 16 weeks based upon disease activity.

Treatment with anti-VEGF agents should only be continued in patients who maintain adequate response to therapy. For

For clarity, coverage will be provided for patients responding to therapy with another anti-VEGF agent who switch to Vabysmo. Coverage will NOT be provided for patients who have failed to respond to other anti-VEGF agents.

650 1 year

For the treatment of patients with clinically significant diabetic macular edema (DME) for whom laser photocoagulation is also indicated; and who have a hemoglobin A1c of less than 12 percent.

Vabysmo is to be administered using one of the following dosing regimens:

Treatment should be initiated with an intravitreal injection every 4 weeks for the first 6 doses, followed by an intravitreal injection at a dosing interval of every 8 weeks.

OR

Treatment should be initiated with an intravitreal injection every 4 weeks for the first 4 doses or until macular edema is resolved. Thereafter, the dosing interval may be extended up to every 16 weeks (4 months) in up to 4-week increments. If anatomic and/or visual outcomes deteriorate, then the treatment interval should be shortened accordingly.

Treatment with anti-VEGF agents should only be continued in patients who maintain adequate response to therapy.

For clarity, coverage will be provided for patients responding to therapy with another anti-VEGF agent who switch to Vabysmo. Coverage will NOT be provided for patients who have failed to respond to other anti-VEGF agents.

 

EAP Criteria

NO

Product Monograph

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