Traditional MedicarePrior AuthHigh impact
Bevacizumab products (Revised)
Humana·FL, KY, SC, VA · Oncology, Ophthalmology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana revised its bevacizumab product policy requiring prior authorization for all covered indications including oncology and ophthalmology uses. Step therapy requirements mandate trying Mvasi or Zirabev before other bevacizumab products for most oncology indications, with specific exceptions for Medicare Part B continuations and Florida Medicaid.
Action Required
By January 1, 2026: Billing team must update prior authorization procedures for all bevacizumab products (Avastin, Mvasi, Zirabev, Vegzelma, Alymsys, Jobevne). For oncology uses, ensure step therapy documentation showing trial of Mvasi or Zirabev first, unless patient has contraindication/intolerance or is continuing therapy within 365 days for Medicare Part B. Update EMR templates to include required clinical criteria for each indication. Claims will be denied without proper prior authorization.