Avelumab (Bavencio) coverage
This policy governs medical necessity and prior authorization criteria for avelumab (Bavencio) for members across Commercial, HIM, and Medicaid lines of business within the payer network. It specifies approved indications, age limits, dosing limits, required documentation, and approval durations.
For MCC, added disease qualifier of locally advanced per NCCN.
Added recurrent Merkel cell carcinoma as a covered indication.
Added requirement that avelumab be used as single-agent therapy for urothelial carcinoma per NCCN.
For off-label indications per NCCN, revised disease qualifiers for thymic carcinoma and added option/requirement for combination with Inlyta (axitinib) for select indications.
For Medicaid/HIM lines of business, initial approval durations revised from 6 months to 12 months.
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.