CommercialPrior AuthMedium impact
PCSK9 Inhibitors
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Internal Medicine, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their PCSK9 inhibitor policy requiring prior authorization for Repatha (evolocumab) with strict criteria including failed statin therapy or statin intolerance. Praluent (alirocumab) is non-covered on all BCBSMS formularies.
Action Required
Immediately: Billing team must ensure prior authorization is obtained before prescribing/billing for Repatha (evolocumab). Verify patient meets strict criteria including cardiovascular conditions, familial hypercholesterolemia, or documented statin therapy failure/intolerance. Do not bill for Praluent (alirocumab) as it is non-covered. Update provider encounter forms to include prior auth reminder for PCSK9 inhibitors. Claims will be denied without proper authorization.