Payer PolicyActive
Beovu® (brolucizumab-dbll)
EVICORE-MEDICAL_DRUG-847A4139
EviCore by Evernorth
Effective: October 1, 2025
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Beovu (brolucizumab‑dbll) is covered only for FDA‑approved neovascular (wet) AMD, diabetic macular edema, and specified compendial off‑label neovascular ophthalmic conditions; other uses are excluded. Coverage requires documentation of the indicated diagnosis, administration by or under an ophthalmologist, adherence to indication‑specific dosing (AMD/other neovascular: 6 mg monthly for 3 doses then every 8–12 weeks; DME: 6 mg every ~6 weeks for 5 doses then every 8–12 weeks), and approvals are valid for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Neovascular (Wet) Age-related Macular Degeneration (AMD)"
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