Wiki Aetna denying Avastin for Occular Conditions

[sphillips50]

Has anyone started receiving denials from Aetna for Avastin for ocular conditions. They are denying as experimental when the diagnosis is covered based on their medical policy. This started about the 2nd week of July. They are saying medical records will have to be submitted on all of the denials. I am checking to see if anyone else is has having this issue and if you were given any information as to why this might be happening all of a sudden.

 

[robynchamness@yahoo.com]

Did it require a prior authorization?

 

[sphillips50]

Yes. We got authorization.

 

[trarut]

You don't mention the diagnosis being used but the Aetna policy for ocular bevacizumab was updated on 7/14/25 and the revision states "This CPB has been revised to state that intravitreal ranibizumab injection (Susvimo) is considered medically necessary for treatment of diabetic macular edema when criteria are met."

https://www.aetna.com/cpb/medical/data/700_799/0701.html

 

[rachaelwilleford]

Aetna has preferred products for all bevacizumab products. I'd check the policy.