Vabysmo (faricimab-svoa) cost per injection and what the patient owes

$31.322 per 0.1 mg is Part B's ASP+6% rate for Q4 2026. Once the $283 Part B deductible is met, the patient owes the remaining 20% coinsurance on the drug and its administration, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →

Medicare pays J2777 per 0.1 mg billing unit, not per vial or per treatment session. The labeled 6 mg dose is the same across all three indications — wet AMD, diabetic macular edema and macular edema after RVO — and works out to 60 units per eye, drawn from one single-dose vial or prefilled syringe and reported with JZ. Only the injection interval changes by indication, not the dose. For one eye, the drug alone allows $1,879.32; adding the 67028 injection procedure (non-facility PFS, $114.23) brings the claim to $1,993.55 allowed, and the patient's 20% coinsurance after the deductible is $398.71.

Injecting both eyes at the same visit is two drug lines, one per eye, plus a single procedure line: J2777 × 60 units RT with JZ, J2777 × 60 units LT with JZ, and 67028 with modifier 50, paid at 150% of the fee schedule ($171.35) instead of two separate 67028 lines. That claim allows $3,929.99, and the patient's 20% coinsurance is $375.86 + $375.86 + $34.27 = $785.99.

Avastin (bevacizumab, off-label and repackaged, J9035) carries no ASP+6% entry in this quarter's pricing file and is omitted from this table; it is nonetheless the product a payer's step therapy most often asks for first. None of these billing-unit definitions convert to another product's units: Eylea bills per 1 mg and Vabysmo per 0.1 mg, and each drug's own labeled dose sets the amount injected, not a converted unit count. Never substitute a dose from one anti-VEGF product for a dose of another.

For the reference patient (6 mg in one eye, drug + the 67028 injection procedure), Medicare allows $1,993.55, and the Part B coinsurance on that is $398.71. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing per dose once the $283 deductible is met. Plans K and L do not. Because Vabysmo is dosed monthly for the first four doses and then every 8 to 16 weeks for wet AMD, the deductible column is what decides most claims for the first dose of the plan year. The dose that lands before the deductible is met costs a Plan K patient $454.05; the dose after it costs $199.35. Unequal charges dose to dose, not one recurring number. See what each Medigap plan (A–N) owes on this claim →

Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.

Commercial payers negotiate their own rate for J2777, not ASP+6%. Our corpus holds published rates from 36 payers, including Aetna, Anthem, Cigna, UnitedHealthcare, Regence and Premera. Aetna’s median is $33.43 per unit against Medicare’s $31.322, putting a 6 mg one-eye dose at $2,005.80 before benefits. Rates move by state as well as by payer, which is why the estimator above takes one. The 67028 injection procedure carries its own commercial copay or coinsurance separate from the drug line, and the Genentech Ophthalmology Co-pay Program, where the patient is eligible, applies to both. What the patient owes then depends on their specific benefits. Full explanation: How commercial drug reimbursement works →

The ASP+6% rate Medicare pays for the drug itself does not change by site of care. The procedure is always 67028, reported per eye — RT or LT on the line, or once with modifier 50 when both eyes are injected at the visit, never 96372. Intravitreal injections are short in-office procedures billed under the physician fee schedule's non-facility rate rather than a hospital-outpatient facility fee. Some commercial payers apply a site-of-care rule to faricimab; our coverage corpus shows 4 of 27 policy sets carry an explicit site-of-care rule. Our data doesn't carry a Vabysmo-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.

Place of service (POS) is what drives that rate split. POS 11 (office) prices the admin code at the non-facility physician fee schedule rate, which is the path this estimator prices. A site-of-care rule that sends the same claim to POS 19 (off-campus hospital outpatient), POS 22 (hospital outpatient) or POS 24 (ambulatory surgical center) moves the admin code to the facility rate instead: a different number for the same CPT code. Confirm the POS on the claim before comparing an admin-fee estimate against what a payer actually paid.

The current quarter's payment limit carries three decimal places in the ASP pricing file: $31.322 per 0.1 mg. The worked examples on this page use that figure; earlier quarters above are shown to two decimals as published. Applied to the same 6 mg one-eye dose, the Q3 2026 rate ($32.381 per 0.1 mg) allowed $1,942.86 for the drug; the Q4 2026 rate, precise at $31.322, allows $1,879.32. Use the quarter that is actually in effect for the claim's date of service.

On a commercial plan, the Genentech Ophthalmology Co-pay Program can take the patient's cost for the drug and administration down to $0, up to $15,000 a year. It excludes Medicare, Medicaid and other government program patients.

There is a free-drug route from the manufacturer: the Genentech Patient Foundation ships Vabysmo at no cost to qualifying uninsured patients at or below 400% of the federal poverty level, but it covers only the drug, not the injection procedure or an office-visit fee. On Medicare, neither program applies: the Co-pay Program excludes Medicare by design, and the Patient Foundation reaches only uninsured patients, never the Part B coinsurance. No foundation fund is on file for Vabysmo today, so a Medigap plan is the only route that reaches $0 on Medicare. See every program for this patient, with current status →

Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (67028, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 36 commercial payer published price files; Genentech Ophthalmology Co-pay Program and Genentech Patient Foundation terms and status (the site's programs bundle, generated from the live programs corpus).

Reviewed September 20, 2026 by Erin Rose, CareCost Estimate founder. Methodology →