CommercialPrior AuthMedium impact
Complement Inhibitors
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Hematology, Nephrology·Medical Policy
Effective date
Aug 15, 2026
We identified it
Jun 20, 2026
Summary
BCBSMS updated their complement inhibitors policy, requiring prior authorization for Epysqli and Ultomiris while removing coverage for Bkemv, Piasky, Soliris, and Zilbrysq from all formularies. Epysqli becomes the preferred eculizumab option effective 8/15/2026.
Action Required
By August 15, 2026: Update billing system to require prior authorization for Epysqli (eculizumab-aagh) and Ultomiris (ravulizumab-cwvz). Remove Bkemv, Piasky, Soliris, and Zilbrysq from covered drug lists as they are not covered on any BCBSMS formulary. Train staff on new preferred drug hierarchy with Epysqli as the formulary eculizumab option. Update prior authorization workflows to include vaccination requirements and specialist enrollment in REMS program.