MedicaidPrior AuthMedium impact
Beovu® (brolucizumab) (Revised)
Humana·LA · Ophthalmology·Medicaid
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Louisiana revised its Beovu (brolucizumab) prior authorization policy effective January 28, 2026. The policy requires prior authorization for Beovu use in neovascular wet AMD and diabetic macular edema, with approval contingent on patient contraindication/intolerance to bevacizumab OR documented failure to respond clinically to prior bevacizumab therapy. Billing teams must implement prior authorization requirements in their workflow before submitting claims for this medication.
Action Required
By January 28, 2026: Billing and authorization teams must implement prior authorization requirements for all Beovu (brolucizumab) claims submitted to Humana Medicaid Louisiana. Update billing system rules to flag Beovu requests for manual prior auth review. Providers must document either (1) patient contraindication/intolerance to bevacizumab, OR (2) prior bevacizumab therapy with evidence of non-response (measured by BCVA, visual field, or vision decline metrics). Front desk and clinical staff should add verification checklist to encounter forms for ophthalmology cases involving macular degeneration or diabetic macular edema. Direct providers to submit clinical documentation with prior auth requests demonstrating patient meets criteria. Claims submitted without prior authorization or inadequate clinical justification will be denied by Humana.