CommercialCoverageHigh impact
Anti-Rheumatic Biologicals
Blue Cross & Blue Shield of Mississippi·MS · Rheumatology, Dermatology, Gastroenterology·Medical Policy
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their anti-rheumatic biologicals policy with new formulary preferences and coverage exclusions. Key changes include Hadlima and Simlandi becoming the only covered adalimumab options effective 01/01/2025, and Selarsdi, Steqeyma, and Yesintek becoming the only covered ustekinumab options effective 08/01/2025. Multiple popular brands including Humira, Stelara, and others are now completely excluded from coverage.
Action Required
By January 1, 2025: Billing team must update prior authorization processes to only request Hadlima or Simlandi for adalimumab prescriptions, and verify patient formulary coverage before prescribing any anti-rheumatic biologicals. Providers must be notified that Humira, Stelara, and 17 other biologicals are no longer covered and will result in claim denials. Update EMR alerts and encounter forms to reflect new formulary restrictions. By August 1, 2025: Switch all ustekinumab requests to Selarsdi, Steqeyma, or Yesintek only.