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Reason for Use code 649 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 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. Coverage limit: LU Authorization Period: 1 year Reason for Use code 650 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. Coverage limit: LU Authorization Period: 1 year Reason for Use code 725 For the treatment of patients with clinically significant macular edema secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Treatment should be initiated with an intravitreal injection every 4 weeks until stable visual acuity improvement and disease control are achieved. The treatment interval may be extended up to 16 weeks (4 months) in up to 4-week increments at a time in patients without disease activity. If anatomic and/or visual outcomes deteriorate, the treatment interval should be shortened accordingly. The interval between doses should not be shorter than one month. Patients should be assessed regularly. 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 this product. Coverage will NOT be provided for patients who have failed to respond to other anti-VEGF agents. Coverage limit: LU Authorization Period: 1 year

Vabysmo · DIN 02527618 Manufacturer: Hoffmann-La Roche Limited; listing date 2023-06-30 Health Canada: Marketed since 2022-07-18 · brand VABYSMO · ATC S01LA09 FARICIMAB · form Solution · route Intravitreal · ingredients FARICIMAB 6 MG/0.05ML · company Hoffmann-la roche limited · schedule Prescription, Schedule d

DIN 02527618: Vabysmo Raw flags: sec12=Y, sec3=Y Item: 523600150; group id 625; item number 1594; lccId 00371; manufacturer id HLR Source form: Inj Sol-0.24mL Vial Pk (Preservative-Free); strength: 6mg/0.05mL Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $1350.0000; ministry $1350.0000 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02527618 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=101666

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