Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
HumanaMedicaid · Prior Auth · Medicaid · FL · Oncology, Ophthalmology, PharmacyHigh impact

Bevacizumab products (New)

Effective date
Oct 28, 2026
Identified
Oct 28, 2026

Summary

Humana Florida Medicaid has established a new prior authorization policy for bevacizumab products (Mvasi, Zirabev, Vegzelma, Avastin) effective October 28, 2026. The policy covers 13 oncologic and ophthalmologic indications with specific clinical criteria requirements for approval. Billing teams must implement prior authorization requirements before dispensing these drugs to Medicaid members.

Get alerts when payers change rules like this one

We check Humana and other payers every day and email you when a change matches your specialty and state.

Get Humana alertsPolicy Monitoring is free. No card required.

What to do

Action · 4 steps
01Effective 2026-10-28: Billing team and pharmacy staff must implement prior authorization requirements in the pharmacy system for all bevacizumab product claims (Avastin, Mvasi, Zirabev, Vegzelma) submitted for Humana Florida Medicaid members.
02Before dispensing or billing, verify that the member's indication matches one of the 13 covered indications (age-related macular degeneration, diabetic macular edema, macular retinal edema, cervical cancer, endometrial cancer, metastatic colorectal cancer, non-small cell lung cancer non-squamous, renal cell carcinoma, recurrent primary CNS tumor, soft tissue sarcoma, malignant pleural mesothelioma, epithelial ovarian/fallopian tube/primary peritoneal cancer, or hepatocellular carcinoma) and meets all clinical criteria specified in the policy.
03Claims submitted without prior authorization approval will be denied.
04Confirm the practice's billing software has been updated to route bevacizumab requests through the prior authorization process and retain documentation of clinical criteria verification with each claim.

Codes mentioned

J9035

Original notice

Bevacizumab products (New)
mcp.humana.com · Always check the source before changing claims.
View original ↗

Related changes

See all Humana changes →
Bevacizumab products (New)HighEffective Oct 28, 2026 · MedicaidBevacizumab products (Revised)HighEffective Jan 1, 2026 · MedicaidBendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) (Revised)HighEffective Jan 1, 2023 · MedicaidBevacizumab productsHighEffective Oct 28, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesFL policy changesOncologyOphthalmologyPharmacyCode J9035

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account