Bevacizumab Shortage: What Providers and Prescribers Need to Know in 2026

Bevacizumab Shortage: A Provider Briefing for 2026

Bevacizumab remains one of the most widely prescribed anti-VEGF agents in oncology, with FDA-approved indications spanning seven cancer types. For providers managing patients on Bevacizumab-containing regimens, supply disruptions create real clinical challenges — from treatment delays to difficult conversations about biosimilar substitution and therapeutic alternatives.

This briefing covers the current shortage landscape, prescribing implications, and practical resources to help you keep your patients on track.

Shortage Timeline: How We Got Here

Bevacizumab supply issues have evolved significantly over the past several years:

• 2017-2019: The first Bevacizumab biosimilars — Mvasi (bevacizumab-awwb, Amgen, approved 2017) and Zirabev (bevacizumab-bvzr, Pfizer, approved 2019) — entered the market, beginning the transition away from sole-source Avastin.
• 2022: Two additional biosimilars gained FDA approval: Alymsys (bevacizumab-maly, Amneal) and Vegzelma (bevacizumab-adcd, Celltrion), expanding the manufacturer base.
• 2023-2024: Intermittent shortages of specific Bevacizumab products appeared on ASHP and FDA shortage lists, coinciding with the broader oncology drug shortage crisis that peaked at 323 active shortages in Q1 2024. Bevacizumab-bvzr (Zirabev) was notably affected.
• 2025-2026: Avzivi (bevacizumab-tnjn, Samsung Bioepis) and Jobevne (bevacizumab-nwgd, Sandoz) received FDA approval, bringing the total to six biosimilars plus brand Avastin. Overall supply has improved, though individual products continue to experience intermittent disruptions.

Prescribing Implications

The current multi-source landscape creates both opportunities and challenges for prescribers:

Biosimilar Interchangeability

All six FDA-approved Bevacizumab biosimilars have demonstrated biosimilarity to reference Avastin through rigorous analytical, nonclinical, and clinical studies. From a clinical perspective, switching between Bevacizumab products is supported by FDA guidance and real-world evidence showing no meaningful differences in efficacy or safety.

However, institutional formulary decisions, payer contracts, and state pharmacy laws may influence which specific product is available at your facility. Maintaining familiarity with multiple biosimilar options — and ensuring your electronic ordering systems can accommodate product switches — is essential during shortage periods.

Dosing Considerations

Bevacizumab dosing varies by indication:

• 5 mg/kg IV every 2 weeks: Metastatic colorectal cancer (with IFL chemotherapy)
• 10 mg/kg IV every 2 weeks: Metastatic colorectal cancer (with FOLFOX4), glioblastoma, renal cell carcinoma
• 15 mg/kg IV every 3 weeks: Non-squamous NSCLC (with carboplatin/paclitaxel), ovarian cancer, cervical cancer, hepatocellular carcinoma (with atezolizumab)

During supply constraints, ensure dosing calculations account for the available vial sizes (100 mg/4 mL and 400 mg/16 mL) to minimize waste. Vial sharing protocols, where permitted by institutional policy and state law, can help stretch limited supply.

Treatment Delays

Short treatment delays (3-7 days) to source Bevacizumab may be clinically acceptable for many patients, though this depends on disease burden, treatment intent, and the specific regimen. Document the clinical rationale for any delay and communicate proactively with patients about the situation.

Current Availability Picture

As of early 2026, the Bevacizumab market includes seven products:

• Avastin (Genentech/Roche) — reference product
• Mvasi (bevacizumab-awwb, Amgen)
• Zirabev (bevacizumab-bvzr, Pfizer)
• Alymsys (bevacizumab-maly, Amneal)
• Vegzelma (bevacizumab-adcd, Celltrion)
• Avzivi (bevacizumab-tnjn, Samsung Bioepis)
• Jobevne (bevacizumab-nwgd, Sandoz)

Not all products are equally available at all facilities. Availability depends on GPO contracts, specialty distributor relationships, and regional distribution patterns. Facilities that maintain multi-source purchasing agreements are better positioned to weather individual product shortages.

Cost and Access Considerations

Biosimilar competition has driven meaningful price reductions for Bevacizumab:

• Brand Avastin WAC: approximately $79.70/10 mg ($3,188 per 400 mg vial)
• Biosimilar WAC: approximately $61.34/10 mg (Zirabev), representing 15-25% discounts from reference product
• Medicare Part B reimbursement: ASP + 6%, with biosimilar reimbursement linked to the biosimilar's own ASP

However, research published in JAMA (March 2026) noted that while acquisition costs for biosimilars have fallen significantly, commercial payer reimbursement rates and hospital markups can create situations where the cost savings don't fully reach patients. Be aware of your facility's specific reimbursement dynamics when counseling patients on costs.

For patients facing financial barriers, several resources exist:

• Genentech Oncology Co-pay Assistance Program: Eligible commercially insured patients may pay as little as $0 for Avastin — call (855) MY-COPAY
• Genentech Patient Foundation: Free Avastin for eligible uninsured/underinsured patients
• Independent foundations: PAN Foundation, HealthWell Foundation, Patient Advocate Foundation

Tools and Resources for Providers

Several tools can help you navigate Bevacizumab supply challenges:

• Medfinder for Providers: Check real-time Bevacizumab availability at facilities in your area and help patients locate supply
• ASHP Drug Shortage Resource Center: Current shortage status, estimated resupply dates, and clinical guidance for managing shortages
• FDA Drug Shortage Database: Official shortage listings with manufacturer-reported supply status
• Genentech Avastin Access Solutions: Dedicated support for providers and patients navigating supply and financial challenges
• NCCN Clinical Practice Guidelines: Guidance on appropriate alternatives when Bevacizumab is unavailable

Therapeutic Alternatives When Bevacizumab Is Unavailable

When Bevacizumab cannot be sourced in any formulation, the following agents may be considered depending on indication:

• Ramucirumab (Cyramza): Anti-VEGFR-2 antibody; approved for gastric cancer, NSCLC, mCRC (with FOLFIRI), and HCC
• Ziv-Aflibercept (Zaltrap): VEGF trap; approved for mCRC with FOLFIRI after oxaliplatin-based failure
• Regorafenib (Stivarga): Oral multikinase inhibitor; approved for mCRC, GIST, and HCC
• Lenvatinib (Lenvima): Oral multikinase VEGFR inhibitor; approved for thyroid cancer, RCC, HCC, and endometrial cancer

Each alternative has distinct indication profiles, dosing, side effects, and evidence bases. Refer to NCCN guidelines and institutional protocols for indication-specific recommendations. For a patient-facing overview, see our alternatives to Bevacizumab guide.

Looking Ahead

Several trends suggest continued improvement in Bevacizumab access:

• Expanding biosimilar manufacturing capacity across multiple global producers
• Increasing payer and institutional adoption of multi-source strategies
• Potential policy changes addressing the buy-and-bill model's vulnerability to shortages
• Growing biosimilar price competition driving improved affordability

However, the broader drug shortage crisis — driven by fragile supply chains, limited manufacturing redundancy, and economic pressures on generic/biosimilar producers — means that intermittent disruptions are likely to continue for the foreseeable future.

Final Thoughts

Managing Bevacizumab access in 2026 requires a proactive, multi-faceted approach. Maintain relationships with multiple distributors, stay current on shortage databases, leverage tools like Medfinder for Providers, and ensure your team is prepared to substitute between biosimilar products. Most importantly, communicate openly with patients about supply situations and the safety of biosimilar switching.

For patient-facing resources you can share, see our patient shortage update and tips for finding Bevacizumab in stock.