Beovu (brolucizumab-dbll)
Billing
Code: J0179
Description: Inj, brolucizumab-dbll, 1 mg
Unit: 1 mg
Payment: $313.475
Pay quarter: Q1 2023
Dosage and Frequency
Neovascular (Wet) Age-related Macular Degeneration (AMD)
Induction:
• 6mg IVT every 4 weeks for the first 3 doses
Maintenance:
• 6mg IVT every 8-12 weeks
Induction:
• 6mg IVT every 4 weeks for the first 3 doses
Maintenance:
• 6mg IVT every 8-12 weeks
Diabetic Macular Edema (DME)
Induction:
• 6mg IVT every 6 weeks for the first 5 doses
Maintenance:
• 6mg IVT every 8-12 weeks
Induction:
• 6mg IVT every 6 weeks for the first 5 doses
Maintenance:
• 6mg IVT every 8-12 weeks
Calculate drug reimbursement
Total Reimbursement:
$1,993.70(ASP: $1,880.85, Margin: $112.85)
Code:
J0179# Units to bill:
6Prior Authorization
Prior auth criteria for Beovu may include but is not limited to:
1. Beovu is indicated for the treatment of wet age-related macular degeneration (AMD).
2. The patient must have a diagnosis of wet AMD confirmed by an ophthalmologist.
3. The patient must have a documented history of inadequate response to or intolerance of other available therapies for wet AMD.
4. The patient must have adequate ocular health, including intraocular pressure and no active ocular inflammation or infection.
5. The patient must not have had any intraocular injections within the past 4 weeks.
6. The patient must have an estimated visual acuity of 20/40 or better in the affected eye.
7. The patient must not have any known hypersensitivity to any of the components of Beovu.
Insurance prior auth guidelines:
Billable NDCs
00078-0827-60
Beovu (NOVARTIS PHARMACEUTICALS CORP.)
6 MG
00078-0827-61
Beovu (NOVARTIS PHARMACEUTICALS CORPORATION)
6 MG
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