Bevax (bevacizumab), which works by suppressing the formation of new blood vessels (angiogenesis) in cancer treatment, is one of the drugs that creates the most confusion in SGK's drug reimbursement practice. This is because the active substance bevacizumab is covered by SGK for certain cancer types and specific treatment lines, while the same drug is not reimbursed when used for a different indication or treatment line. This article examines when Bevax is covered, when litigation becomes necessary, and how that process works. A comparable picture applies to Trodelvy (sacituzumab govitecan), which has not been added to SGK's reimbursement list at all; the two drugs are comparable in terms of coverage that varies by indication.
What Is Bevax (Bevacizumab) and How Does It Work?
Bevacizumab is an anti-angiogenic targeted therapy that slows the growth and spread of cancer cells by blocking the formation of new blood vessels (the VEGF pathway) that a tumour needs for nourishment. Bevax is a biosimilar of this active substance licensed in Turkey in 2021; the reference product containing the same active substance is known on the market under the brand Altuzan. Bevacizumab is mainly used in:
- Metastatic colon and rectal cancer
- Non-small cell lung cancer (in certain combinations)
- Glioblastoma multiforme (a high-grade brain tumour)
- Certain ovarian, cervical, and kidney cancer cases
Under What Circumstances Does SGK Cover Bevax?
SGK reimburses the active substance bevacizumab not in every mode of use, but only in indications meeting the specific conditions listed in the Health Implementation Communiqué (SUT). For example, it is covered when used:
- In combination with 5-fluorouracil/folinic acid or irinotecan regimens, as first-line treatment for metastatic colon or rectal cancer,
- In patients not previously treated with bevacizumab, as second-line and later treatment with specific combinations,
- In glioblastoma cases meeting specific criteria.
However, when these SUT-defined conditions are exceeded — for example, in a different cancer type, a different treatment line, or prescribed without meeting the required performance/report conditions — SGK may refuse payment. In practice, SGK has been seen to refuse payment particularly in certain indications such as lung cancer, prompting patients to seek an interim injunction from the court so that the drug cost is covered without interruption.
For this reason, the question "does SGK cover Bevax?" has no single answer; it depends on which cancer type, which treatment line, and which combination it is used with.
Bevax 2026 Price
Bevax is a biosimilar product containing bevacizumab, and its price tracks a similar band to the reference product containing the same active substance. Based on current reference prices, a 100 mg vial costs approximately 6,000-6,500 TL, and a 400 mg vial approximately 23,000 TL. Because dosing is calculated based on the patient's weight according to the treatment protocol, the total cost of a cycle varies with the number of vials used. It is advisable to confirm the current, near-exact price with a pharmacy or hospital.
Legal Process When SGK Refuses Payment
If Bevax is properly prescribed within an indication covered by SUT, SGK's refusal to pay is an unlawful act and can be challenged in court. If the use falls outside SUT's scope, the process takes the form of an "off-label drug case." In both situations, the steps are:
- Preparation of a health board report: An oncology specialist prepares a report showing that the disease type, stage, and treatment line meet the criteria required by SUT (or, where they do not, that the drug is medically necessary).
- [Application to TİTCK](/en/ictihat/kanser-ilaci-yetkili-mahkeme) (for off-label use): If the drug will be used outside the indication defined in SUT, obtaining off-label use approval from the Turkish Medicines and Medical Devices Agency strengthens the process.
- Written application to SGK: Submitted to the Provincial Directorate of SGK together with the report and any TİTCK approval.
- Filing a case: If SGK refuses or remains silent, a case is filed before the labour court or administrative court depending on the patient's insurance status.
- Request for an interim injunction: Requested so that treatment is not interrupted and SGK covers the drug cost while the case is pending.
Required Documents
- Oncology specialist's report and health board report
- Pathology results and discharge summary
- Documents showing the treatment line used (prior chemotherapy regimens)
- The application made to SGK and any refusal letter
- Drug invoices, if the cost was paid out of pocket
Duration of Proceedings
SGK cases concerning Bevax can conclude in different timeframes depending on whether the case is based on an indication covered by SUT or an off-label use. Cases based on an unjustified refusal within SUT's scope can proceed relatively quickly, while off-label cases can take 6 to 18 months due to the expert examination process. If the request for an interim injunction is granted, treatment can continue without interruption while the case is pending.
Frequently Asked Questions
Is there a difference between Bevax and Altuzan in terms of SGK payment?
Since both contain the same active substance (bevacizumab), SGK's reimbursement rules are determined by the active substance and indication; the brand alone does not change the coverage outcome.
In which cancer types does SGK cover Bevax?
Mainly certain lines of metastatic colorectal cancer treatment and some glioblastoma cases — a limited number of indications listed in SUT.
Can SGK refuse payment even for a use covered by SUT?
Cases where SGK refuses payment despite a properly issued report and prescription do occur in practice; these can be challenged in court as an action for annulment of the administrative decision.
What is the purpose of an interim injunction request?
It ensures SGK temporarily covers the drug until the case is concluded, preventing an interruption in treatment.
Do I necessarily need a lawyer before filing a case?
It is not mandatory, but given the technical nature of SUT's provisions and the risk of missing deadlines, support from an experienced lawyer in this field contributes to a properly conducted process.
Frequently Searched Questions
How Should a Petition for a Bevax SGK Application Be Prepared?
The petition should include pathology and discharge reports showing the type and stage of the disease, an oncology health board report stating the treatment line (first-line or later), treatment records showing the patient has not previously received bevacizumab, and SGK's refusal letter.
Where Is the Cost of Bevax Obtained From?
For indications listed in SUT (certain lines of metastatic colorectal cancer, eligible glioblastoma cases), Bevax is supplied through hospital pharmacies under SGK's protocol. For indications outside SUT's scope, such as lung cancer, the drug may need to be purchased out of pocket from a private pharmacy until an interim injunction is obtained through litigation.
Can the Amount Paid for Bevax Be Reclaimed?
Yes. Bevax costs paid out of pocket due to an unjustified refusal within a SUT-covered indication can be reclaimed through litigation supported by invoices; the claim is subject to the 5-year limitation period under Article 97 of Law No. 5510.
Why Does SGK Refuse Bevax Requests?
The most common ground is prescribing the drug outside the limited list of indications defined in SUT (colorectal cancer, glioblastoma) — for example, in lung, ovarian, or cervical cancer. A treatment line that does not match the sequence defined in SUT is another frequent ground for refusal.
Which Court Hears a Bevax Case?
Insured persons under SSK or Bağ-Kur file their case before the labour court, while civil servants and retired civil servants within the scope of Article 4/c of Law No. 5510 file before the administrative court.
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