CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Itvisma (onasemnogene abeparvovec-brve)
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Pediatrics, Family Medicine·Medical Policy
Effective date
Jun 15, 2026
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Plan has added a new policy declaring Itvisma (onasemnogene abeparvovec-brve) gene therapy for spinal muscular atrophy as not medically necessary due to available formulary alternatives. Claims for this drug and its administration will be denied.
Action Required
By June 15, 2026: Billing team must update system to flag HCPCS code C9309 (onasemnogene abeparvovec-brve injection) as not covered for Mississippi State and School Employees' Health Plan members. Verify formulary alternatives are available before treatment. Claims for C9309 and related administration services will be denied without coverage determination.