Description: Inj. byooviz, 0.1 mg
Unit: 0.1 mg
Pay quarter: Q4 2023
Dosage and Frequency
Macular Edema Following Retinal Vein Occlusion(RVO)
• 0.5mg IVT every 1 month
• 0.5mg IVT every 1 month for up to 3 months
Calculate drug reimbursement
(ASP: $941.28, Margin: $56.48)
# Units to bill:5
Prior auth criteria for Byooviz may include but is not limited to:
1. The patient must have a clinical diagnosis of wet age-related macular degeneration (AMD) that is confirmed by fluorescein angiography or optical coherence tomography (OCT).
2. The patient must have had an inadequate response to or intolerance to one or more other therapies.
3. The patient must not have any other active ocular diseases that could interfere with the evaluation of the effectiveness of Byooviz.
4. The patient must not have any intraocular inflammation or infection.
5. The patient must not have any contraindication to Byooviz, such as hypersensitivity to any of the components.
6. The patient must not have any prior treatment with Byooviz.
7. The patient must be at least 18 years of age.
Insurance prior auth guidelines: