CommercialPrior AuthHigh impact
Bevacizumab for Non-Ocular Indications (CPB 0685, reviewed 2026-04-07)
Aetna·Oncology, Hematology, Neurology +6 more·Medical Policy
Effective date
Apr 7, 2026
We identified it
Aug 12, 2026
Summary
Aetna has updated its clinical policy for bevacizumab (Avastin and biosimilars) for non-ocular indications, effective April 7, 2026. This policy clarifies covered cancer indications, establishes mandatory precertification requirements for all oncology uses, and implements a new site-of-care utilization management policy for specialty drug infusions. The policy applies to Aetna commercial plans only and requires precertification via phone or fax before treatment initiation.
Action Required
By April 7, 2026: (1) Billing team must implement mandatory precertification workflow for ALL bevacizumab claims (Avastin J9035, biosimilars Alymsys, Avzivi, Jobevne, Mvasi, Vegzelma, Zirabev) for oncology indications only. (2) Update billing system to require precertification submission before claim submission; calls to (866) 752-7021 or faxes to (888) 267-3277 must be documented in patient record. (3) Providers must verify patient's cancer diagnosis matches Aetna's approved indications list (ampullary adenocarcinoma, appendiceal neoplasms, CNS cancers, cervical cancer, colorectal cancer, endometrial carcinoma, hepatocellular carcinoma, mesothelioma, NSCLC, ovarian/fallopian tube/peritoneal cancers, RCC, small bowel adenocarcinoma, soft tissue sarcoma, vaginal cancer, vulvar cancer). (4) Update oncology encounter forms to capture required diagnosis and treatment details for precertification. (5) Coordinate with pharmacy/specialty infusion center to implement new site-of-care utilization management policy per Aetna's January 1, 2026 specialty drug infusions policy. (6) Train billing staff that bevacizumab for non-approved indications will be considered experimental/investigational and denied. Claims submitted without precertification will be denied and require resubmission after approval.