Helpful Resources for Your Practice

Genentech Ophthalmology Access Solutions offers a range of access and reimbursement resources for your patients and practice after SUSVIMO is prescribed, including help with benefits investigations (BIs), resources for prior authorizations (PAs), sample billing and coding information, resources for denials and appeals, information about distribution and referrals to potential financial assistance options.

Quick Links

Help with Coverage (BIs and PAs)

Reimbursement (Billing, Coding and Appeals)

Online Patient Enrollment

SUSVIMO Distribution

Coverage

Get help understanding insurance benefits and coverage, such as with benefits investigations and prior authorization resources.

Benefits Investigations

Genentech Ophthalmology Access Solutions can conduct a benefits investigation (BI) which can determine:

If treatment is covered
If treatment is denied
If a prior authorization or pre-determination is required*
If your patient's insurance plan has a mandated or preferred specialty pharmacy

*If your patient’s request for a prior authorization is not granted, your Genentech Ophthalmology Access Solutions specialist can work with you to determine your next steps.

Get started with enrollment by following the steps below.

Option 1: Submit online

If your practice has a registered account for My Patient Solutions, you can get started by logging into your account.

Go to My Patient Solutions

Don't have an account?

Launch Quick Enroll

Your patient is required to complete the Patient Consent Form. You can either upload their Patient Consent Form as part of your application or have your patient submit the form via fax, text or e-submit.

An online tool to help you enroll patients in Genentech Ophthalmology Access Solutions and manage your service requests at your convenience.

Option 2: Print & fax or text

Step 1: Print one of the Patient Consent Forms below for your patient to complete.

Step 2: Print and complete the Prescriber Service Form below.

Prescriber Service Form

Step 3: Submit the completed forms via fax or text.

Send via fax to (866) 480-7762
Text a photo of the form to 650-877-1111

Both forms are required. We must have both the Patient Consent Form and the Prescriber Service Form before we can help you.

What to expect next:

The request will be processed within five business days upon receipt of both required forms.
Your office will be contacted to discuss any next steps.

Get started with enrollment by following the steps below.

Option 1: Submit online

If your practice has a registered account for My Patient Solutions, you can get started by logging into your account.

Go to My Patient Solutions

Don't have an account?

Launch Quick Enroll

Your patient is required to complete the patient consent section of the Patient Consent Form. You can either upload the patient consent section of the Patient Consent Form as part of your online application or have your patient submit the patient consent section of the Patient Consent Form via fax, text or e-submit.

An online tool to help you enroll patients in Genentech Ophthalmology Access Solutions and manage your service requests at your convenience.

Option 2: Print & fax or text

Step 1: Print Patient Consent Form below and have your patient complete the patient consent section of this form.

Step 2: Submit the completed form via fax or text.

Send via fax to (866) 480-7762
Text a photo of the form to 650-877-1111

Both sections of the form are required. We must have both sections of the completed Patient Consent Form before we can help you.

What to expect next:

The request will be processed within five business days upon receipt of both patient and prescriber consent.
Your office will be contacted to discuss any next steps.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.

SUSVIMO Case Managers

A Case Manager may assist during your patient's treatment with coverage, reimbursement and financial assistance support.

Learn more about SUSVIMO Case Managers

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Eligible patients can receive up to a 8$starterCoverageDelay/8$ supply of SUSVIMO. Once coverage has been determined, the patient no longer qualifies for 8$theStarterProgram/8$.

Subject to eligibility requirements and terms and conditions. This program is void where prohibited by law and may not be used in or by residents of restricted states, if applicable.

View full TERMS AND CONDITIONS

SUSVIMO Benefits Reverification

When a medical treatment is authorized by the patient’s insurance plan for a limited period of time, it will generally require reverification of coverage for continued treatment. Genentech Ophthalmology Access Solutions can help you obtain reverification for your patients.

If the patient’s health insurance plan denies the request for reverification, your practice may file an appeal on behalf of your patient.

Reimbursement

Sample coding information and resources for denials and appeals

SUSVIMO Sample Coding

This coding information may assist you as you complete the payer forms for SUSVIMO. These tables are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding.

Sample Coding: Neovascular (wet) age‑related macular degeneration (AMD)

Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.

Appeals

If your patient’s health insurance plan has issued a denial, your Genentech Ophthalmology Access Solutions specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.

If a plan issues a denial:

The denial should be reviewed, along with the health insurance plan’s guidelines to determine what to include in your patient’s appeal submission.
Your Genentech Ophthalmology Access Solutions specialist has local payer coverage expertise and can help you determine specific requirements for your patient.

A sample appeal letter and additional considerations are available on the Practice Forms & Documents page.

Appeals cannot be completed or submitted by Genentech on your behalf.

Online Patient Enrollment

My Patient Solutions is an online tool to help you enroll patients in Genentech Ophthalmology Access Solutions and manage your service requests, all through one portal. It allows you the flexibility to work with Genentech Ophthalmology Access Solutions when it’s convenient for you.

With My Patient Solutions, you can:

Enroll and re-enroll patients in Genentech Ophthalmology Access Solutions and/or the Genentech Patient Foundation
View Genentech Patient Foundation eligibility and coordinate shipment
Communicate with your Genentech Ophthalmology Access Solutions specialist
Easily identify next steps for service requests
View Benefits Investigation reports for all your enrolled patients
Follow up on prior authorizations or appeals
Request benefits reverification

How to register

Account registration can be completed by one person for the entire practice and for multiple practice locations. For help with registration or if you have questions, call us at 877-GENENTECH (877-436-3683) (6AM-5PM PST, Monday through Friday).

SUSVIMO Distribution

Genentech Ophthalmology Access Solutions works with specialty pharmacies (SPs) to help patients receive their prescribed Genentech medicines.

In addition to distributing medicines, a specialty pharmacy may provide the following services:

Reimbursement resources
Clinical services to help patients throughout their treatment
The ability to manage the specialty handling and shipping needs linked with many specialty therapies

You can work with your preferred specialty pharmacy or contact Genentech Ophthalmology Access Solutions to learn which specialty pharmacy the patient’s health insurance plan mandates or prefers.

Genentech does not influence or advocate the use of any one specialty distributor or specialty pharmacy. We make no representation or guarantee of service or coverage of any item. For any product-specific distribution questions, call Genentech Ophthalmology Access Solutions at (833) EYE-GENE/(833) 393-4363 (6AM-5PM PST, Monday through Friday).

Genentech has contracted with authorized specialty distributors and specialty pharmacies to service practices choosing to prescribe SUSVIMO.

These partners have made a commitment to product integrity and have agreed to distribute only products purchased directly from Genentech and not to distribute SUSVIMO through secondary channels.

Authorized Distributors

For a full list of authorized distributors, please visit the Genentech Access Solutions website or contact Genentech Ophthalmology Access Solutions at (833) EYE-GENE/(833) 393-4363.

About Buy and Bill

With Buy and Bill, the practice purchases the medication in advance, then bills the patient's health insurance plan for reimbursement. The practice is responsible for storing and handling the drug as well as collecting the patient's co-pay for both the drug and its administration. With Buy and Bill, practices can maintain a stock of the drug, giving them the flexibility to treat patients when clinically appropriate.

About Specialty Pharmacies

Genentech Ophthalmology Access Solutions works with specialty pharmacies (SPs) to help patients receive their prescribed Genentech medicines.

In addition to distributing medicines, an SP may provide the following services:

Reimbursement resources
Clinical services to support patients throughout their treatment
The ability to manage the specialty handling and shipping needs linked with many specialty therapies

SUSVIMO has more than 20 in-network specialty pharmacies. For a full list of in-network specialty pharmacies, please contact Genentech Ophthalmology Access Solutions at (833) EYE-GENE/(833) 393-4363.

For information on how to request product access, specialty pharmacies can visit our Indirect Access Program website.

You can work with your preferred SP or contact Genentech Ophthalmology Access Solutions to learn which SP the patient’s health insurance plan mandates or prefers.

For a full list of in-network specialty pharmacies, please visit the Genentech Access Solutions website or contact Genentech Ophthalmology Access Solutions at (833) EYE-GENE/(833) 393-4363.

Product Issues

We are serious about patient safety. If your Genentech product is spoiled, expired or damaged, we may be able to help you replace it.

Need more help? Click here to find the latest information.

Please contact Genentech Customer Service at 800-551-2231 for any order or return-related questions.

Questions? Contact Genentech Ophthalmology Access Solutions

Call (833) EYE-GENE/(833) 393-4363 (Mon.–Fri., 6AM–5PM PST, except major holidays).

Financial Support

Find the right financial resources option for your patients.

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Indication

SUSVIMO (ranibizumab injection) is indicated for the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) who have previously responded to at least 2 intravitreal injections of a vascular endothelial growth factor (VEGF) inhibitor medication.

WARNING: ENDOPHTHALMITIS

The SUSVIMO implant has been associated with a 3-fold higher rate of endophthalmitis than monthly intravitreal injections of ranibizumab. Many of these events were associated with conjunctival retractions or erosions. Appropriate conjunctiva management and early detection with surgical repair of conjunctival retractions or erosions may reduce the risk of endophthalmitis. In clinical trials, 2.0% of patients receiving a ranibizumab implant experienced at least 1 episode of endophthalmitis.

Contraindications

SUSVIMO is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or hypersensitivity to ranibizumab products or any of the excipients in SUSVIMO.

Warnings and Precautions

The SUSVIMO implant and/or implant-related procedures have been associated with endophthalmitis, rhegmatogenous retinal detachment, implant dislocation, septum dislodgement, vitreous hemorrhage, conjunctival erosion, conjunctival retraction, and conjunctival blebs. Patients should be instructed to report any signs or symptoms that could be associated with these events without delay. In some cases, these events can present asymptomatically. The implant and the tissue overlying the implant flange should be monitored routinely following the implant insertion and refill-exchange procedures to permit early medical or surgical intervention as necessary. Special precautions need to be taken when handling SUSVIMO components.

Endophthalmitis

In the active comparator period of controlled clinical trials, the ranibizumab implant has been associated with a 3-fold higher rate of endophthalmitis than monthly intravitreal injections of ranibizumab (1.7% in the SUSVIMO arm vs 0.5% in the intravitreal arm). When including extension phases of clinical trials, 2.0% (11/555) of patients receiving the ranibizumab implant experienced an episode of endophthalmitis. Reports occurred between day 5 and day 853, with a median of day 173. Many, but not all, of the cases of endophthalmitis reported a preceding or concurrent conjunctival retraction or erosion event.

Endophthalmitis should be treated promptly in an effort to reduce the risk of vision loss and maximize recovery. The SUSVIMO dose (refill-exchange) should be delayed until resolution of endophthalmitis.

Patients should not have an active or suspected ocular or periocular infection or severe systemic infection at the time of any SUSVIMO implant or refill procedure. Appropriate intraoperative handling followed by secure closure of the conjunctiva and Tenon’s capsule, and early detection and surgical repair of conjunctival erosions or retractions may reduce the risk of endophthalmitis.

Rhegmatogenous Retinal Detachment

Rhegmatogenous retinal detachments have occurred in clinical trials of SUSVIMO and may result in vision loss. Rhegmatogenous retinal detachments should be promptly treated with an intervention (e.g., pneumatic retinopexy, vitrectomy, or laser photocoagulation). The SUSVIMO dose (refill-exchange) should be delayed in the presence of a retinal detachment or retinal break.

Careful evaluation of the retinal periphery is recommended to be performed, and any suspected areas of abnormal vitreo-retinal adhesion or retinal breaks should be treated before inserting the implant in the eye.

Implant Dislocation

In clinical trials, the device dislocated/subluxated into the vitreous cavity or extended outside the vitreous cavity into or beyond the subconjunctival space. Device dislocation requires urgent surgical intervention. Strict adherence to the scleral incision length and appropriate targeting of the pars plana during laser ablation may reduce the risk of implant dislocation.

Septum Dislodgement

In clinical trials, a type of implant damage where the septum has dislodged into the implant body has been reported. Perform a dilated slit lamp exam and/or dilated indirect ophthalmoscopy to inspect the implant in the vitreous cavity through the pupil prior to and after the refill-exchange procedure to identify if septum dislodgement has occurred. Discontinue treatment with SUSVIMO following septum dislodgement and consider implant removal should the benefit of the removal procedure outweigh the risk.

Appropriate handling and insertion of the refill needle into the septum (avoid twisting and/or rotation) is required to minimize the risk of septum dislodgement.

Vitreous Hemorrhage

Vitreous hemorrhages may result in temporary vision loss. Vitrectomy may be needed in the case of a nonclearing vitreous hemorrhage.

In clinical trials of SUSVIMO, including extension phases, vitreous hemorrhages were reported in 5.2% (23/443) of patients receiving SUSVIMO. The majority of these hemorrhages occurred within the first postoperative month following surgical implantation, and the majority of vitreous hemorrhages resolved spontaneously. Patients on antithrombotic medication (e.g., oral anticoagulants, aspirin, nonsteroidal anti-inflammatory drugs) may be at increased risk of vitreous hemorrhage. Antithrombotic medications are recommended to be temporarily interrupted prior to the implant insertion procedure. The SUSVIMO dose (refill-exchange) should be delayed in the event of sight-threatening vitreous hemorrhage. The use of pars plana laser ablation and scleral cauterization should be performed to reduce the risk of vitreous hemorrhage.

Conjunctival Erosion or Retraction

A conjunctival erosion is a full-thickness degradation or breakdown of the conjunctiva in the area of the implant flange. A conjunctival retraction is a recession or opening of the limbal and/or radial peritomy. Conjunctival erosions or retractions have been associated with an increased risk of endophthalmitis, especially if the implant becomes exposed. Surgical intervention (e.g., conjunctival/Tenon’s capsule repair) is recommended to be performed in cases of conjunctival erosion or retraction with or without exposure of the implant flange.

In clinical trials of SUSVIMO, including extension phases, 3.6% (16/443) of patients receiving SUSVIMO reported conjunctival erosion and 1.6% (7/443) of patients receiving SUSVIMO reported conjunctival retraction in the study eye.

Appropriate intraoperative handling of the conjunctiva and Tenon’s capsule to preserve tissue integrity and secure closure of peritomy while ensuring placement of sutures away from implant edge may reduce the risk of conjunctival erosion or retraction. The implant and the tissue overlying the implant flange should be monitored routinely following the implant insertion.

Conjunctival Bleb

A conjunctival bleb is an encapsulated elevation of the conjunctiva above the implant flange, which may be secondary to subconjunctival thickening or fluid. Conjunctival blebs may require surgical management to avoid further complications, especially if the implant septum is no longer identifiable due to the conjunctival bleb.

In clinical trials of SUSVIMO, including extension phases, 5.9% (26/443) of patients receiving SUSVIMO reported conjunctival bleb/conjunctival filtering bleb leak in the study eye. Strict adherence to the scleral incision length, appropriate intraoperative handling of the conjunctiva and Tenon’s capsule to preserve tissue integrity and secure closure of peritomy, and proper seating of the refill needle during refill-exchange procedures may reduce the risk of conjunctival bleb.

Postoperative Decrease in Visual Acuity

Visual acuity was decreased by an average of 4 letters in the first postoperative month and an average of 2 letters in the second postoperative month following initial implantation of SUSVIMO.

Air Bubbles Causing Improper Filling of the Implant

Minimize air bubbles within the implant reservoir, as they may cause slower drug release. During the initial fill procedure, if an air bubble is present, it must be no larger than ⅓ of the widest diameter of the implant. If excess air is observed after initial fill, do not use the implant. During the refill-exchange procedure, if excess air is present in the syringe and needle, do not use the syringe and needle. If excess air bubbles are observed after the refill-exchange procedure, consider repeating the refill-exchange procedure.

Deflection of the Implant

Use caution when performing ophthalmic procedures that may cause deflection of the implant and subsequent injury. For example, B-scan ophthalmic ultrasound, scleral depression, or gonioscopy.

Adverse Reactions

In the nAMD Archway study following the SUSVIMO initial fill and implant insertion, refill, and implant removal (if necessary) procedures up to week 40, the most common (≥10%) adverse reactions up to week 40 were conjunctival hemorrhage (72%), conjunctival hyperemia (26%), iritis (23%), and eye pain (10%).

Females and Males of Reproductive Potential

Females of reproductive potential should use effective contraception during treatment with SUSVIMO and for at least 12 months after the last dose of SUSVIMO. No studies on the effects of ranibizumab on fertility have been conducted and it is not known whether ranibizumab can affect reproduction capacity. Based on the anti-VEGF mechanism of action for ranibizumab, treatment with SUSVIMO may pose a risk to reproductive capacity.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

Please see additional Important Safety Information in the full SUSVIMO Prescribing Information, including BOXED WARNING.

- SUSVIMO [package insert]. South San Francisco, CA: Genentech, Inc; 2022.
  
  SUSVIMO [package insert]. South San Francisco, CA: Genentech, Inc; 2022.
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- SUSVIMO Initial Fill and Implant Procedure Instructions for Use. Genentech, Inc. 2022.
  
  SUSVIMO Initial Fill and Implant Procedure Instructions for Use. Genentech, Inc. 2022.
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