CommercialCoverageMedium impact
Yeztugo (lenacapavir)
Blue Cross & Blue Shield of Mississippi·MS · Infectious Disease, Internal Medicine, Family Medicine·Medical Policy
Effective date
Mar 15, 2026
We identified it
Jun 20, 2026
Summary
BCBSMS has added a new policy classifying Yeztugo (lenacapavir) for HIV pre-exposure prophylaxis as not medically necessary, meaning claims will be denied as there are covered alternatives available. Both oral and injection forms are affected.
Action Required
By March 15, 2026: Billing team must update system to flag HCPCS codes J0738 and J0752 as non-covered for BCBSMS plans. Providers should be notified that Yeztugo (lenacapavir) for HIV PrEP will be denied and to prescribe covered alternatives instead. Claims for these codes will be denied without prior authorization approval.