Medicare AdvantageCoverageMedium impact
MA08.122e, Avelumab (Bavencio®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated medical necessity criteria and medical coding requirements for Avelumab (Bavencio®), a cancer immunotherapy drug. This policy change affects pharmacy coverage and billing requirements for this specialty oncology medication.
Action Required
Effective December 29, 2025: Billing team and providers must review updated medical necessity criteria for Avelumab (Bavencio®) prescriptions for Medicare Advantage patients. Ensure documentation meets new requirements and verify any coding changes for this oncology medication. Contact Medicare Advantage plans for specific prior authorization requirements.