Summary
Humana's pharmacy coverage policy for bevacizumab products (Avastin, Mvasi, Zirabev, Alymsys, Vegzelma, Jobevne) is dated effective 10/28/2026 for Medicare, Medicaid Kentucky, Medicaid South Carolina, and Medicaid Virginia. It sets prior authorization criteria by indication, including a step-therapy requirement that members have an intolerance or contraindication to Mvasi or Zirabev before Avastin, Alymsys, Jobevne, or Vegzelma oncology requests, plus indication-specific diagnosis and regimen requirements. Billing teams should verify these criteria against the current policy version before scheduling affected infusions.
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What to do
Action · 5 steps
01Effective 2026-10-28 (per source; analysis date 2026-11-05 is after this date, so confirm current applicability with Humana's current policy version): Providers and front desk staff should obtain prior authorization before scheduling bevacizumab products for Medicare, Medicaid Kentucky, Medicaid South Carolina, and Medicaid Virginia members, and document the indication-specific criteria (diagnosis, disease stage/line of therapy, and paired agents such as carboplatin/paclitaxel or atezolizumab) in the chart.
02Billing team: for Avastin, Alymsys, Jobevne, and Vegzelma oncology requests, confirm the chart documents an intolerance or contraindication to Mvasi or Zirabev, and add this check to the prior auth tracker.
03Medicare Part B continuation of prior therapy within 365 days is exempt from the step-therapy requirement, so flag those charts for that exception.
04Claims without prior authorization will be denied per the payer's process, so verify authorization status in the prior auth tracker before submission and update charge entry to match the approved drug, indication, and HCPCS billing.
05Watch Humana's notices for the next revision.
Original notice
Bevacizumab products
mcp.humana.com · Always check the source before changing claims.