Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) (PDF)
Defines medical necessity, initial and continuation criteria, approved FDA and selected off-label indications, step-therapy redirection to preferred biosimilars, dosing limits, approval durations, dose rounding guidance, and coding implications for bevacizumab and listed biosimilars for Centene lines of business (Commercial, HIM, Medicaid).
Multiple historical updates listed (addition of biosimilars, NCCN-supported regimens, appendix updates, HCPCS code updates) with dates across 2021-2023.
Commercial approval duration revised to 12 months or duration of request, whichever is less.
Added HCC indication in combination with atezolizumab/Tecentriq and dosing.
Added multiple NCCN-supported indications (e.g., ampullary adenocarcinoma, malignant peritoneal mesothelioma, pediatric diffuse high-grade glioma) in 4Q2022 review.
Updated HCPCS coding: added Q5126 and later Q5129 and Q5160; removed C9142.
Added biosimilars (Vegzelma, Avzivi, Jobevne, others) to policy as FDA approvals occurred.
4Q2023 and 4Q2024 annual reviews revised numerous oncology indication criteria per NCCN (NSCLC, RCC, ovarian, HCC, CRC, cervical cancer).
4Q2025 annual review: added step therapy bypass for IL HIM per IL HB 5395 and extended initial approval duration for Medicaid and HIM from 6 to 12 months for maintenance medication.
Updated Appendix E to include Oklahoma, Mississippi, Tennessee, Indiana at various dates.
Added additional off-label oncology uses and required combination therapy in some off-label contexts (e.g., ampullary adenocarcinoma, mesothelioma, small bowel adenocarcinoma, vulvar cancer).
Ophthalmology uses clarified to remove age restriction and require ophthalmologist prescriber; added radiation retinopathy and retinopathy of prematurity.
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.