Summary
BCBSMS's Immunoglobulin Therapy policy states that prior authorization is required, and the 06/15/2026 update added Yimmugo to the products not covered on any BCBSMS Formulary. The same effective-dated update revised the medically necessary criteria for formulary intravenous and subcutaneous immunoglobulin therapy and changed the investigational list to specify sepsis in adults. Alyglo, Asceniv, Bivigam, Cuvitru, Flebogamma DIF, Gammagard S/D, Gammaplex, GamaSTAN, Hyqvia, Panzyga and Yimmugo are listed as not covered.
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What to do
Action · 8 steps
01Already effective 06/15/2026: Billing team: Perform a formulary drug search on the patient's member ID to confirm the prescription drug is covered under their benefit plan, because the medication may not be covered under a specific member's plan.
02Yimmugo is not covered on any BCBSMS Formulary, so confirm coverage before scheduling or billing it.
03Prior authorization is required under this policy.
04Services related to delivery or administration of a medication that has not been approved through the BCBSMS prior authorization review process will be considered not medically necessary.
05Formulary IVIG and SCIG therapy must meet the policy criteria, including the prescriber being a specialist or having consulted with a specialist, and the prescribed dosage must be within program quantity limits based on FDA approved labeling.
06Approvals last up to 12 months.
07Letters of support are often useful but are not sufficient documentation unless all information needed for a medical necessity determination is included, and provider medical records listing previously prescribed medications will not show medication trials or adherence.
08Other applications of SCIG therapy are considered investigational.
Codes mentioned
90281902839028490291J0850J1459J1551J1558J1559J1561J1566J1568J1569J1599J1552J1553J1554J1555J1556J1557J1560J1572J1575J1576B20D80.1D80.0D80.5D82.0D81.82D69.3G25.82G61.0G61.82G62.81M30.3M31.30M31.31P55.8P55.9P61.0R78.81Z48.22Z94.0Z48.21Z48.280Z94.1Z94.3Z48.24Z94.2Z48.23Z94.4Z48.290Z94.81Z94.83
Original notice
Immunoglobulin Therapy
bcbsms.com · Always check the source before changing claims.
Related changes
See all Blue Cross & Blue Shield of Mississippi changes →Plasma ExchangeMediumNo effective date · Medical PolicyState and School Employees' Health Insurance Plan - Immune ThrombocytopeniaHighNo effective date · Medical PolicyImmune ThrombocytopeniaHighNo effective date · Medical PolicyAllogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired AnemiasMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list
Related policy hubs
Blue Cross & Blue Shield of Mississippi policiesAllergy & ImmunologyHematologyNeurologyCode 90281Code 90283Code 90284Code 90291Code J0850Code J1459Code J1551Code J1558Code J1559Code J1561Code J1566Code J1568Code J1569Code J1599Code J1552Code J1553Code J1554Code J1555Code J1556Code J1557Code J1560Code J1572Code J1575Code J1576Code B20Code D80.1Code D80.0Code D80.5Code D82.0Code D81.82Code D69.3Code G25.82Code G61.0Code G61.82Code G62.81Code M30.3Code M31.30Code M31.31Code P55.8Code P55.9Code P61.0Code R78.81Code Z48.22Code Z94.0Code Z48.21Code Z48.280Code Z94.1Code Z94.3Code Z48.24Code Z94.2Code Z48.23Code Z94.4Code Z48.290Code Z94.81Code Z94.83