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Bevacizumab products (Revised)
Act
by Jan 1, 2026 (or immediately if already past)
Effective date
Jan 1, 2026
Identified
Aug 1, 2026
Summary
Humana Medicaid Ohio revised its Bevacizumab products prior authorization policy effective January 1, 2026, with updates on June 24, 2026. The policy establishes specific clinical criteria for coverage of six bevacizumab products (Avastin, Mvasi, Zirabev, Vegzelma, Alymsys, Jobevne) across 13 indications, including requirements that patients have intolerance/contraindication to preferred biosimilars before accessing alternative products for oncology indications. Billing teams must verify prior authorization requirements are met before claim submission for all bevacizumab products in Ohio Medicaid.
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What to do
by Jan 1, 2026 (or immediately if already past) · 7 steps
01Billing and Prior Authorization teams must update systems to enforce this revised policy for all Humana Ohio Medicaid members.
02Configure system to require prior authorization submission for ALL bevacizumab product requests (Avastin, Mvasi, Zirabev, Vegzelma, Alymsys, Jobevne - HCPCS J9035 and J9400).
03For oncology indications, implement rule requiring documentation that member has intolerance or contraindication to Mvasi or Zirabev before approving Avastin, Alymsys, Jobevne, or Vegzelma.
04Add indication-specific criteria verification to prior auth workflow (e.g., for metastatic colorectal cancer, verify combination therapy type and chemotherapy agent; for NSCLC, verify non-squamous histology and no prior bevacizumab progression).
05Update provider documentation templates and encounter forms to capture required clinical details per indication.
06Train prior authorization staff on new criteria and exclusions (e.g., no EGFR inhibitor co-use for colorectal cancer; no bevacizumab after disease progression for lung cancer and RCC).
07Flag denials for claims submitted without prior authorization or failing to meet indication-specific criteria.
If missed: Failure to obtain prior authorization will result in claim denials under Ohio Medicaid.
Codes mentioned
J9035J9400
Original notice
Bevacizumab products (Revised)
mcp.humana.com · Always check the source before changing claims.
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