CommercialCoverageLow impact
Gene Therapy for the Treatment of Hemophilia B
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology·Medical Policy
Effective date
Dec 2, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their gene therapy policy to specify that Beqvez and Hemgenix gene therapies for Hemophilia B are not medically necessary due to available formulary alternatives. The policy was refined to remove previous language about treatment guidelines not addressing these therapies' place in therapy.
Action Required
By December 2, 2025: Billing team must ensure prior authorization requests for HCPCS codes J1411 (Hemgenix) and J1414 (Beqvez) include documentation of medical necessity and failed trials of formulary alternatives for Hemophilia B patients. Update billing system to flag these codes for BCBSMS PA review process. Claims without approved PA will be denied as not medically necessary.