Prior authorization: biosimilars vs brand Avastin

Bevacizumab biosimilar products do not require prior authorization; however, the use of brand Avastin requires an evaluation of medical necessity (prior authorization) prior to approval except when used for ophthalmic conditions.

Require prior therapy for recurrent CNS tumors

For certain indications the patient must have tried at least one prior therapy before bevacizumab is considered — for example, recurrent CNS tumors require prior exposure to at least one previous therapy (examples: temozolomide, etoposide, carmustine, or radiotherapy).

• Applies to CNS tumors (recurrent disease) per FDA‑approved criteria.
• Examples of prior therapies listed in policy: temozolomide (capsules or injection), etoposide, carmustine, radiotherapy.

Documentation to support brand Avastin prior authorization

When requesting coverage for brand Avastin (non‑ophthalmic uses), submit documentation that supports medical necessity, including the specific FDA‑approved or guideline‑supported indication and prior therapies when required (e.g., prior systemic or listed therapies for recurrent CNS tumors).

• State the indication being treated and reference the FDA‑approved dosing regimen where applicable.
• Include documentation of prior therapies when required by the indication (see CNS tumor examples).

Non‑NCCN indications are not recommended for approval

Requests for bevacizumab for indications not listed as recommendations in the NCCN Drugs & Biologics Compendium are not recommended for coverage and may be denied.

• If the requested use is outside NCCN recommendations, coverage is not recommended per policy.
• Clinical Resources will be updated as new data become available; expect denial for non‑NCCN uses.