Payer PolicyActive
Brolucizimab (Beovu)
EVICORE-MEDICAL_DRUG-25485FDB
EviCore by Evernorth
Effective: November 1, 2020
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Beovu (brolucizumab‑dbII) is covered for FDA‑approved neovascular (wet) AMD and specified off‑label neovascular ophthalmic conditions and is not covered for uses outside those listed indications. Coverage requires intravitreal administration by or under an ophthalmologist with documentation of diagnosis and dosing per the recommended schedule (6 mg monthly ×3, then every 8–12 weeks), and approvals are issued for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Beovu is indicated for the treatment of Neovascular (Wet) Age-related Macular Degeneration (AMD)."
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