CommercialPrior AuthMedium impact
Brolucizumab-dbll (Beovu®)
BCBS Tennessee·TN · Ophthalmology·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
BlueCross BlueShield of Tennessee is implementing a new medical policy for Brolucizumab-dbll (Beovu®) effective December 1, 2026, covering treatment of neovascular (wet) age-related macular degeneration and diabetic macular edema. The policy requires step therapy approval and restricts prescribing to ophthalmologists. Initial and continuation authorizations are limited to 12-month periods with documented clinical response required for reauthorization.
Action Required
By November 15, 2026: Billing and clinical teams must prepare for implementation of this new policy. (1) Obtain and review the Step Therapy Requirements guide referenced in the policy at https://www.bcbst.com/docs/providers/Comm_BC_PAD_Step_Therapy_Guide.pdf. (2) Update billing system rules to require step therapy verification before processing Beovu® claims for both wet AMD and DME indications. (3) Ensure all encounter forms and prior authorization workflows restrict prescriber specialty to ophthalmology only. (4) Configure authorization expiration rules to flag reauthorization requirements at 12 months with mandatory documentation of clinical response (BCVA improvement, visual field maintenance, or reduced vision decline). (5) Train billing staff on the policy requirements and step therapy procedures. (6) Add system edits to reject claims for non-FDA-approved indications as experimental/investigational. Failure to implement step therapy requirements will result in claim denials for Beovu® administered claims.