Bevacizumab (Avastin®)

Avastin (bevacizumab) is covered only for compendia-supported non-oncology neovascular/vascular ophthalmic conditions (e.g., diabetic macular edema/retinopathy, RVO-related macular edema, myopic choroidal neovascularization, neovascular AMD, ROP, neovascular glaucoma, sickle cell neovascularization); oncology uses are outside this policy. Coverage requires documentation of a compendial-supported diagnosis, fulfillment of the policy’s specific coverage and safety criteria, administration by or under an ophthalmologist’s supervision, and is authorized for a 12‑month approval period.

"Neovascular or vascular ophthalmic conditions"

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