Avelumab (Bavencio) (CPB 0916, reviewed 2026-10-14)

Billing and precertification teams must verify current applicability of this Aetna Bavencio coverage policy and implement the following workflows: (1) Precertification team should ensure all requests for avelumab (Bavencio) are submitted via precertification (call 866-752-7021 or fax 888-267-3277) before dispensing; (2) Billing team should verify that prior to authorizing coverage, members do not have documented disease progression on prior PD-1 or PD-L1 inhibitor therapy (nivolumab, pembrolizumab, atezolizumab, avelumab, or durvalumab), as these members are excluded from coverage; (3) Verify the requested indication matches one of the covered indications (Merkel cell carcinoma, renal cell carcinoma, bladder cancer, urothelial carcinoma, gestational trophoblastic neoplasia, endometrial carcinoma, thymic carcinoma, extranodal NK/T-cell lymphoma, colorectal adenocarcinoma, or small bowel adenocarcinoma) with specific combination or sequencing criteria met before authorizing claim payment; (4) For colorectal and small bowel adenocarcinoma neoadjuvant treatment, ensure authorization duration does not exceed 6 months total; (5) Confirm site-of-care utilization management policy compliance per Aetna's specialty drug infusion guidelines. Claims submitted without meeting these criteria will be denied. Check with Aetna to confirm whether this policy remains current and applicable to your contracted plans.