CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Complement Inhibitors
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Nephrology, Neurology·Medical Policy
Effective date
Aug 15, 2026
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi has updated their medical policy for complement inhibitor drugs, establishing Epysqli as the preferred eculizumab formulary option effective 8/15/2026, while removing coverage for Bkemv, Piasky, and Soliris. The policy sets strict prior authorization criteria for covered complement inhibitors including specific age requirements, diagnostic confirmation, and treatment failure documentation.
Action Required
By August 15, 2026: Billing team must update prior authorization protocols for complement inhibitor drugs (Epysqli and Ultomiris) to verify patient meets all diagnostic criteria including flow cytometry confirmation, immunization status, and treatment failure documentation. Remove Bkemv, Piasky, and Soliris from covered drug lists for Mississippi State Health Plan members. Update provider encounter forms to include required documentation elements for PNH, aHUS, gMG, and NMOSD diagnoses.