Brolucizimab (Beovu®)
EVICORE-MEDICAL_DRUG-9EA2BE46
Beovu (brolucizumab) is covered only for FDA‑approved neovascular (wet) AMD and diabetic macular edema and for specified compendial off‑label neovascular ophthalmic indications; uses outside these FDA‑approved or listed compendial indications are excluded. Coverage requires intravitreal administration by or under the supervision of an ophthalmologist, documentation of the qualifying diagnosis and dosing per the policy (neovascular AMD/other neovascular eye disease: 6 mg monthly ×3 then 6 mg every 8–12 weeks; DME: 6 mg every 39–45 days ×5 then 6 mg every 8–12 weeks), and authorization is valid for 12 months.
"Beovu is indicated for the treatment of Neovascular (Wet) Age-related Macular Degeneration (AMD)."
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