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Benefits Investigation

 

Why is a benefits investigation important?

 

Avastin Access Solutions conducts a Benefits Investigation (BI) to help you better understand your patient's health plan coverage for some or all of the costs associated with Avastin treatment. The BI can also determine if a prior authorization or patient assistance might be needed.

 

To have Avastin Access Solutions conduct a BI, all you need to do is request our assistance on the signed Statement of Medical Necessity (SMN) form.

 

 

 

There are 3 possible outcomes of a BI:

  • Treatment is covered
  • Prior authorization is required
  • Treatment is denied

 

To begin with Avastin Access Solutions, you must complete and submit the SMN and have your patient complete and submit a Patient Authorization and Notice of Release of Information (PAN) form.

 

The SMN can be submitted online via My Patient Solutions or downloaded from Forms and Documents.

Patients can access the PAN through Forms and Documents or submit the PAN online here.

 

This description of a BI is for informational purposes only. The completion and submission of a BI are the responsibility of the patient and your office. Avastin Access Solutions makes no representation or guarantee concerning reimbursement or coverage for any service or item.

 

Prior Authorization

 

Avastin Access Solutions can help your practice identify whether a prior authorization (PA) is needed and help you in the process of securing it. All we need to begin are a completed and signed Statement of Medical Necessity (SMN) form requesting our assistance with the PA as well as a signed and dated Patient Authorization and Notice of Release of Information (PAN) form.

 

 

 

 

Avastin Access Solutions can help you as you submit the required PA forms and documentation. If the PA is not granted, Avastin Access Solutions can work with you to determine your next steps. Tips like this can be found in Forms and Documents.

FAQs

Q: How long does it take to establish coverage for Avastin?
A: Several factors affect when and where patients may receive treatment. The time it takes to assess a PA varies among plans. In most cases, it takes 15 to 45 days to establish coverage. In some cases, a PA is not needed.

Q: If the PA is approved, what is the approval duration?
A: Approval lengths can vary among health plans. Contact the plan to determine the duration of the authorization. Be aware of deadlines, since some can be as early as one month after the approval date.

Did you know...


 

  • Learn more about prior authorizations by downloading our Prior Authorization Tips in Forms and Documents.
  • For a checklist to help you conduct a prior authorization, visit Forms and Documents.
  • Make sure you have everything you need for an appeal by downloading an Appeals Checklist in Forms and Documents.

 

Learn More About
Avastin
  • LEARN about treatment with Avastin
  • **Important Information Regarding Counterfeit Drug **
  • LEARN HOW the Genentech BioOncology Co-pay Card can help with the out-of-pocket costs for Avastin
  • Download: new forms for enrollment in GATCF
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

INDICATIONS

Glioblastoma (GBM)
Avastin is indicated for the treatment of glioblastoma as a single agent for adult patients with progressive disease following prior therapy. The effectiveness of Avastin in glioblastoma is based on an improvement in objective response rate. There are no data demonstrating an improvement in disease-related symptoms or increased survival with Avastin.

Metastatic colorectal cancer (MCRC)
Avastin is indicated for the first- or second-line treatment of patients with metastatic carcinoma of the colon or rectum in combination with intravenous 5-fluorouracil–based chemotherapy.

Avastin, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy, is indicated for the second-line treatment of patients with metastatic colorectal cancer who have progressed on a first-line Avastin-containing regimen.

Limitation of Use: Avastin is not indicated for adjuvant treatment of colon cancer.

Non-squamous non-small cell lung cancer (NSCLC)
Avastin is indicated for the first-line treatment of unresectable, locally advanced, recurrent or metastatic non–squamous non–small cell lung cancer in combination with carboplatin and paclitaxel.

Metastatic renal cell carcinoma (mRCC)
Avastin is indicated for the treatment of metastatic renal cell carcinoma in combination with interferon alfa.

Boxed WARNINGS

  • Gastrointestinal (GI) perforation

    - Serious and sometimes fatal GI perforation occurs at a higher incidence in Avastin-treated patients compared to controls

    - The incidences of GI perforation ranged from 0.3% to 2.4% across clinical studies

    - Discontinue Avastin in patients with GI perforation

  • Surgery and wound healing complications

    - The incidence of wound healing and surgical complications, including serious and fatal complications, is increased in Avastin-treated patients

    - Do not initiate Avastin for at least 28 days after surgery and until the surgical wound is fully healed. The appropriate interval between termination of Avastin and subsequent elective surgery required to reduce the risks of impaired wound healing/wound dehiscence has not been determined

    - Discontinue Avastin at least 28 days prior to elective surgery and in patients with wound healing complications requiring medical intervention

  • Hemorrhage

    - Severe or fatal hemorrhage, including hemoptysis, GI bleeding, hematemesis, central nervous system hemorrhage, epistaxis, and vaginal bleeding, occurred up to 5-fold more frequently in patients receiving Avastin. Across indications, the incidence of grade ≥3 hemorrhagic events among patients receiving Avastin ranged from 1.2% to 4.6%

    - Do not administer Avastin to patients with serious hemorrhage or recent hemoptysis (≥1/2 tsp of red blood)

    - Discontinue Avastin in patients with serious hemorrhage (ie, requiring medical intervention)

Additional serious adverse events

  • Additional serious and sometimes fatal adverse events with increased incidence in the Avastin-treated arm vs control included

    - Non-GI fistula formation (≤0.3%)

    - Arterial thromboembolic events (grade ≥3, 2.6%)

    - Proteinuria (nephrotic syndrome, <1%)

  • Additional serious adverse events with increased incidence in the Avastin-treated arm vs control included

    - Hypertension (grade 3–4, 5%–18%)

    - Reversible posterior leukoencephalopathy syndrome (RPLS) (<0.1%)

  • Infusion reactions with the first dose of Avastin were uncommon (<3%), and severe reactions occurred in 0.2% of patients
  • Inform females of reproductive potential of the risk of ovarian failure prior to starting treatment with Avastin

Most common adverse events

  • Across indications, the most common adverse reactions observed in Avastin patients at a rate >10% and at least twice the control arm rate were
    - Epistaxis - Proteinuria - Lacrimation disorder
    - Headache - Taste alteration - Back pain
    - Hypertension - Dry skin - Exfoliative dermatitis
    - Rhinitis - Rectal hemorrhage  
  • Across all studies, Avastin was discontinued in 8.4% to 21% of patients because of adverse reactions

Pregnancy warning

  • Avastin may impair fertility
  • Based on animal data, Avastin may cause fetal harm
  • Advise patients of the potential risk to the fetus during and following Avastin and the need to continue adequate contraception for at least 6 months following the last dose of Avastin
  • For nursing mothers, discontinue nursing or Avastin, taking into account the importance of Avastin to the mother

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch.

You may also report side effects to Genentech at (888) 835-2555.

Please see accompanying full Prescribing Information, including Boxed WARNINGS, for additional important safety information.

Avastin® and the Access Solutions logo are registered trademarks of Genentech, Inc.