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Neonatal Fc Receptor Blockers
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
BCBSMS's neonatal Fc receptor blockers policy requires prior authorization, and the use of samples is not considered current or stable therapy. Rystiggo (rozanolixizumab-noli) may be considered medically necessary for generalized myasthenia gravis when the listed criteria are met. Vyvgart, Vyvgart Hytrulo and Imaavy (nipocalimab-aahu) are considered not medically necessary because other formulary alternatives are covered by the Plan, and the 06/15/2026 policy history entry removed the brand names Soliris and Ultomiris from the policy section.
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What to do
Action · 10 steps
01Billing team: Prior authorization is required for these neonatal Fc receptor blockers.
02For Rystiggo (rozanolixizumab-noli), confirm the individual is 18 years of age or older, has a documented diagnosis of generalized Myasthenia Gravis with a positive anti-AChR or anti-MuSK antibody, has an MGFA clinical classification of class II-IV, and has an MG-ADL total score of at least 6.
03Confirm one of the following is documented: an inadequate response to corticosteroids and at least one immunosuppressive therapy, an FDA-labeled contraindication, intolerance or hypersensitivity to all conventional agents, or required chronic IVIG or plasmapheresis at least every 3 months over 12 months without symptom control.
04Confirm Rystiggo is not used in combination with a complement inhibitor such as eculizumab or ravulizumab, or with another neonatal Fc receptor blocker.
05Confirm the prescriber is a specialist or has consulted with one, that there is no FDA-labeled contraindication, and that the dosage is within program quantity limits.
06Initial approval is for 6 months.
07Renewal requires prior approval through the BCBSMS PA process, documented clinical response such as a 3-point or greater MG-ADL improvement from baseline, the same prescriber, combination and dosage requirements, and renewal approval is for 12 months.
08Vyvgart (efgartigimod alfa-fcab), Vyvgart Hytrulo and Imaavy are considered not medically necessary under this policy, so check the State Health Plan Medical Drug Formulary before billing them.
09Services related to delivery or administration of a medication that was not approved through the BCBSMS PA review process will be considered not medically necessary.
10Medication trials are determined from pharmacy claims over the preceding twelve months, and for new members the member or requesting provider must obtain and submit pharmacy records upon request, since medical records listing previously prescribed medications are not sufficient.
Codes mentioned
J9333J9256C9305J9332J9334G70.00G70.01
Original notice
Neonatal Fc Receptor Blockers
bcbsms.com · Always check the source before changing claims.
Related changes
See all Blue Cross & Blue Shield of Mississippi changes →State and School Employees' Health Insurance Plan - Neonatal Fc Receptor BlockersMediumNo effective date · Medical PolicyComplement InhibitorsMediumEffective Aug 15, 2026 · Medical PolicyPlasma ExchangeMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list