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DrugsBeovu® (brolucizumab-dbll) [Novartis Pharmaceuticals Corporation]

April 2020

Therapeutic area - Macular Degeneration Agents

Approval criteria

  • Patient is 18 years or older AND
  • Patient is free of ocular and/or peri-ocular infections AND
  • Patient does not have active intraocular inflammation AND
  • Beovu is prescribed by an ophthalmologist AND
  • Therapy will not be used with other ophthalmic VEGF inhibitors (i.e., aflibercept, ranibizumab, pegaptanib, bevacizumab) AND
  • Patient has baseline measurement of the best corrected visual acuity (BCVA) AND
  • Patient has a definitive diagnosis of Neovascular (Wet) Age-Related Macular Degeneration (AMD)

Renewal criteria

  • Patient continues to meet the criteria identified above AND
  • Absence of unacceptable toxicity from the drug. Examples of unacceptable toxicity include the following: endophthalmitis and retinal detachments; increase in intraocular pressure; arterial thromboembolic events AND
  • Patient has had a beneficial response to therapy (e.g., improvement in the baseline best corrected visual acuity [BCVA]) AND
  • Continued administration is necessary for the maintenance treatment of the condition

Quantity limits

  • Initial dosing: 1 vial (6 mg) per eye every 25 days for 3 doses
  • Maintenance dosing: 1 vial (6 mg) per eye every 56 to 84 days

Billing for Beovu

Beovu must be billed as a medical claim.


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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