Oncology (Injectable) Bevacizumab Products Utilization Management Medical Policy
Criteria and prior authorization guidance for medical-benefit coverage of bevacizumab intravenous products for oncology indications (non-ophthalmic) for CareSource members; applies to prescribers and authorization reviewers.
Central Nervous System Tumors: a requirement was added that the patient is ≥ 18 years of age and pediatric CNS Tumors criteria were referenced for pediatric patients.
Hepatocellular Carcinoma: requirement added that the patient is ≥ 18 years of age and Child-Pugh Class A (later amended to A or B) disease; criteria for unresectable/metastatic or transplant-ineligible disease were added.
Mesothelioma: added age ≥ 18 years and removed the word 'malignant' from disease descriptors; bevacizumab removed as single-agent maintenance option.
New pediatric central nervous system tumors indication and additional adult tumor-type inclusions (e.g., ampullary adenocarcinoma, pediatric medulloblastoma) were added.
Non-small cell lung cancer (NSCLC): age requirement ≥ 18 added; actionable mutation considerations updated including removal of KRAS G12C as non-actionable and additions of NTRK and other targeted therapy notes.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.