Medicare AdvantagePrior AuthHigh impact
Beovu® (brolucizumab) (Revised)
Humana·FL, KY, SC · Ophthalmology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated its prior authorization requirements for Beovu® (brolucizumab) injections for wet macular degeneration and diabetic macular edema, effective January 1, 2025. The policy requires step therapy through bevacizumab and other anti-VEGF medications before approving Beovu, with some exceptions for Medicare Part B continuation therapy and Florida Medicaid.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Beovu (brolucizumab) injections before administration. Providers must document contraindication/intolerance to bevacizumab OR failed response to bevacizumab, plus trial of other anti-VEGF medications (Byooviz, Eylea, Eylea HD, Pavblu, Vabysmo, Lucentis for wet AMD; Eylea, Eylea HD, Pavblu, Vabysmo, Lucentis for DME). Update scheduling protocols to verify prior auth before injection appointments. Claims will be denied without proper prior authorization.