Beovu®
Drugs - Beovu® (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.
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411
