Payer PolicyActive
Bevacizumab (Avastin)
EVICORE-MEDICAL_DRUG-3A0932EA
EviCore by Evernorth
Effective: December 1, 2018
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Bevacizumab (Avastin) is covered only for selected non‑oncology, compendia‑supported ophthalmologic indications (diabetic retinopathy, neovascular AMD, diabetic macular edema, macular edema from retinal vein occlusion, and macular choroidal neovascularization); oncology uses are excluded. Coverage requires an approved off‑label compendial indication with clinical documentation that the patient meets the specific coverage and safety criteria, and approvals are limited to up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Diabetic Retinopathy"
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