CommercialCoverageMedium impact
Risk-Reducing Medications for Primary Breast Cancer
Blue Cross & Blue Shield of Mississippi·MS · Oncology, OB-GYN, Family Medicine +1 more·Medical Policy
Effective date
Jun 3, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi added exemestane (Aromasin) to their list of covered risk-reducing medications for primary breast cancer prevention. The policy now covers four medications (tamoxifen, raloxifene, anastrozole, exemestane) for women ≥35 years old who meet specific risk criteria including ≥1.7% five-year breast cancer risk.
Action Required
By June 3, 2025: Billing team must update prior authorization systems to include exemestane (Aromasin) as a covered risk-reducing medication for breast cancer prevention. Ensure documentation includes patient age ≥35 years, validated risk assessment showing ≥1.7% five-year breast cancer risk (Gail Model or Tyrer-Cuzick), and absence of FDA contraindications. For State Health Plan members, submit prior authorization requests to CVS Caremark pharmacy benefit manager.