CommercialPrior AuthMedium impact
Reblozyl (luspatercept-aamt)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Reblozyl (luspatercept-aamt) medical policy with revised criteria for beta thalassemia and myelodysplastic syndrome patients. The policy now explicitly states that drug samples cannot be used to satisfy current/stable therapy requirements and extends initial approval length to 6 months.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Reblozyl (HCPCS J0896) claims. Update billing system to flag that drug samples cannot be used to demonstrate current therapy for PA requirements. Verify patients meet updated criteria including transfusion requirements (≥6 RBC units in 24 weeks for beta thalassemia, ≥2 RBC units in 8 weeks for MDS) before submitting claims. Coordinate with hematology/oncology providers to ensure proper documentation of diagnosis-specific requirements.