CommercialPrior AuthLow impact
Givlaari (givosiran)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Gastroenterology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their prior authorization policy for Givlaari (givosiran), a specialty medication for acute hepatic porphyria. The policy includes strict initial criteria requiring documented attacks and specialist prescriber requirements, with 6-month initial approvals and 12-month renewals.
Action Required
Immediately: Billing team must ensure prior authorization is obtained before administering Givlaari (givosiran) injection J0223. Verify patient meets all criteria including age ≥18, documented AHP diagnosis, history of attacks within 6 months, and specialist prescriber. Update billing system to flag J0223 as requiring prior auth for BCBS MS. Claims will be denied without proper authorization.