Prior authorization for Avastin is required under the Injectable Chemotherapy Prior Authorization Program for the following health plans:
- UnitedHealthcare Oxford Health Plans
- UnitedHealthcare Individual & Employee Plans (excluding Indemnity / PPO membership)
- Neighborhood Health Partnership
- Golden Rule Insurance Company
- UnitedHealthcare Life Insurance Company
- UnitedHealthcare Community Plans for select states; see the Injectable Chemotherapy Prior Authorization Program for details
The administration of Avastin will be reviewed for compliance with the NCCN Compendium recommended uses for the drug as it pertains to a treatment regimen and/or line of therapy.
Non-compliant services will not be eligible for coverage. Applicable state mandates are applied to all case reviews in addition to the terms of the member's plan coverage.