Payer PolicyActive
Beovu® (brolucizumab-dbll)
EVICORE-MEDICAL_DRUG-EAA7E312
EviCore by Evernorth
Effective: October 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered: Beovu is covered only for neovascular (wet) AMD, diabetic macular edema (DME), and the listed compendial off‑label neovascular ophthalmic conditions; other uses are excluded. Key requirements: documented diagnosis of a listed indication, administration by or under an ophthalmologist with documentation, adherence to the intravitreal dosing schedule (AMD: 6 mg monthly ×3 then q8–12 weeks; DME: 6 mg q6 weeks ×5 then q8–12 weeks), and approvals are issued for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Neovascular (Wet) Age-related Macular Degeneration (AMD)"
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