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State and School Employees' Health Insurance Plan - Neonatal Fc Receptor Blockers

Blue Cross & Blue Shield of Mississippi·MS · Neurology·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

New policy establishes prior authorization requirements for neonatal Fc receptor blockers used to treat myasthenia gravis. Only Rystiggo is covered with strict criteria including failed conventional therapies and specialist prescribing. Vyvgart products and Imaavy are deemed not medically necessary.

Action Required

Action needed
Immediately: Billing team must implement prior authorization requirements for Rystiggo (rozanolixizumab-noli) prescriptions. Verify patients meet all criteria including positive antibody tests, MGFA class II-IV, MG-ADL score ≥6, and failed conventional therapies. Ensure prescribing neurologist documents all requirements. Claims for Vyvgart and Imaavy will be denied as not medically necessary - redirect to formulary alternatives.

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