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Injectable Oncology
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Injectable Oncology policy covering 52 specialized cancer medications. Prior authorization is required for most drugs, with specific medical necessity criteria including FDA approval or NCCN guidelines compliance. Several newer drugs are considered not medically necessary due to available formulary alternatives.
Action Required
Immediately: Billing team must verify formulary status for each injectable oncology medication before administration using patient's member ID. Obtain prior authorization for all covered injectable oncology drugs except Opdivo (nivolumab) and Enhertu (fam-trastuzumab deruxtecan-nxki). Ensure genetic testing documentation is available when required. Claims for non-approved medications will be denied as not medically necessary.