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Bevacizumab Products (Avastin®; Mvasi® ; Zirabev™; Alymsys®; Vegzelma™, Avzivi®, Jobevne™)
BCBS Tennessee·TN · Oncology, Ophthalmology, Neurology +1 more·Medical Policy
We identified it
Sep 10, 2026
Summary
This is a comprehensive medical policy for bevacizumab products (Avastin and biosimilars) covering FDA-approved indications for multiple cancer types and ophthalmic disorders, plus compendial uses. The policy establishes 12-month authorization periods for covered indications and requires step therapy per a separate guide. Note: The document header states 'Do Not Implement 12/1/26,' indicating this is a draft policy not yet effective.
Action Required
CRITICAL: DO NOT IMPLEMENT THIS POLICY YET. The document header explicitly states 'Do Not Implement 12/1/26,' meaning this is a draft version scheduled for future implementation. Billing team action required: (1) Flag this policy in your tracking system with a reminder to re-review on November 1, 2026, approximately 30 days before the December 1, 2026 scheduled implementation date. (2) When the policy becomes active on 12/1/26, update prior authorization workflows to require 12-month pre-authorizations for all bevacizumab products used for covered cancer and ophthalmic indications. (3) Review the referenced Step Therapy Requirements document (https://www.bcbst.com/docs/providers/Comm_BC_PAD_Step_Therapy_Guide.pdf) to identify which agents require step therapy and configure billing system accordingly. (4) For ophthalmic indications, ensure claims include documentation that prescriber is an ophthalmologist or has ophthalmology consultation. (5) Configure system to deny claims for non-covered indications (all uses not listed in FDA-approved or compendial sections). Without these changes post-12/1/26, claims will be denied for missing prior authorization or incorrect authorization periods.