Universal API Implementation Guide - Local Development build (v1.1.20) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Release 2025 Feb 28

ANNOUNCEMENTS

• Susvimo indication for Diabetic Macular Edema (DME) was approved by the FDA on 2/4/2025.
• Susvimo indication for Neovascular (wet) Age-related Macular Degeneration (AMD) was updated.
• There is no change to Ophthalmology Prescriber Form version M-US-00006694(v6.0)
• FDA approved indications (ICD10 codes) can be found on the Access Solutions website for Susvimo
• Access Susvimo Copay questionnaires for updated indications.
  
  

Copay Enrollment - SUSVIMO (DME)

Type	Available in QA (test) environment?	Product(s) impacted	linkId impacted (if applicable)	OLD	New	Comment
Add	Yes	Susvimo	linkId: susvimo-fda-approved-indications	-	valueCoding.code: Diabetic-Macular-Edema-(DME)-who-have-previously-responded-to-at-least-two-intravitreal-injections-of-a-VEGF-inhibitor	New DME indication
Update	Yes	Susvimo	linkId: susvimo-fda-approved-indications	valueCoding.code: Neovascular-(wet)-age-related-macular-degeneration-(wAMD)	valueCoding.code: Neovascular-(wet)-Age-related-Macular-Degeneration-(AMD)-who-have-previously-responded-to-at-least-two-intravitreal-injections-of-a-VEGF-inhibitor	AMD verbiage updated

Copay Enrollments: Update to Group Number(s) Received in Enrollment Response Bundle

Overview: Group Numbers received in the Copay Response bundle will now reflect the Master Group Number for each portfolio. This update affects products with:

1. Drug & copay programs
2. Products within a portfolio containing multiple products
   

Details: Each portfolio has a Master Group Number representing an overarching set of programs that could be assigned to one member ID. This Master Group Number is used to process a claim at the pharmacy. It can be found in:

1. The enrollment letter mailed to the patient
2. The Copay Administrator Patient Portal (if the patient has an account)
3. By contacting the Copay Administrator Customer Support Line
   

Impact: This update ensures the correct Master Group Number is reflected in the Copay Response bundle, improving claim processing consistency.

Exception: This update does not impact products that are already passing the Master Group Number in the Copay Response bundle:

• Xolair
• Hemlibra
• Enspryng
• Esbriet
• Evrysdi
• PiaSky
• Pulmozyme
  

Master Group Numbers

Portfolio	Master Group #
Actemra	EC38541004
BioOncology	EC38548001
Enspryng	EC38526001
Esbriet	EC38523002
Evrysdi	EC38525001
Hemlibra	99995209
Ocrevus	EC38517002
Ocrevus Zunovo	EC38517002
Ophthalmology	EC38532001
PiaSky	99995273
Pulmozyme	EC38516003
Rituxan (Immunology)	EC38543004
Xolair	99995223

Examples:

Portfolio	Product	Has Drug/Admin Program	OLD Group# Displayed on Copay Response	Updated Group# Displayed on Copay Response
Ophthalmology	Vabysmo	Yes	Vabysmo Drug SubGroup Number "EC38532004" Ophthalmology Admin SubGroup Number "EC38532005"	Vabysmo Drug Group Number "EC38532001" Ophthalmology Admin Group Number "EC38532001"
BioOncology	Cotellic Zelboraf	No	Cotellic Drug SubGroup Number "EC38548004" Zelboraf SubGroup Number "EC38548019" Tecentriq Drug SubGroup Number "EC38548017"	Cotellic Drug Group Number "EC38548001" Tecentriq Drug Group Number "EC38548001" Zeloboraf Drug Group Number "EC38548001"
Rheumatology	Rituxan for Immunology	Yes	Rituxan SubDrug Group Number "EC38512002" Rituxan Admin SubGroup Number "EX38512003"	Rituxan Drug Group Number "EC38543004" Rituxan Admin Group Number "EC38543004"
Ocrevus	Ocrevus	Yes	Ocrevus Drug SubGroup Number ""EC38517004"	Ocrevus Drug Group Number "EC38517002"