CommercialCoverageMedium impact
Itvisma (onasemnogene abeparvovec-brve)
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Pediatrics, Internal Medicine·Medical Policy
Effective date
Jun 15, 2026
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has added a new policy declaring Itvisma (onasemnogene abeparvovec-brve), a gene therapy for spinal muscular atrophy, as not medically necessary due to available formulary alternatives. All services related to this medication will require prior authorization approval or will be denied.
Action Required
By June 15, 2026: Billing team must update system to flag HCPCS code C9309 (Itvisma injection) as requiring prior authorization through BCBSMS PA review process before administration. Update encounter forms and EMR to alert providers that this medication is considered not medically necessary and alternative formulary options should be considered first. Claims for C9309 without prior auth approval will be denied.