CommercialAdministrativeMedium impact
08.01.64e, Avelumab (Bavencio®)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.64e for Avelumab (Bavencio®) has been updated effective 12/29/2025 with changes to medical necessity criteria and medical coding requirements. The billing team must review updated coverage guidelines and coding standards for this immunotherapy drug to ensure compliant claim submission.
Action Required
By 12/29/2025: Billing team must access and review the full policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=12&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-01-64e to identify specific medical necessity criteria changes and updated coding requirements for Avelumab (Bavencio®). Update billing software rules, prior authorization protocols, and claim submission workflows accordingly. Ensure providers are notified of any new documentation requirements. Notify claims examiners to flag Avelumab claims for verification against updated criteria to prevent denials.