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State and School Employees' Health Insurance Plan - Cablivi (caplacizumab-yhdp)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology, Critical Care·Medical Policy
We identified it
Jun 20, 2026
Summary
New medical policy established for Cablivi (caplacizumab-yhdp) for treatment of acquired thrombotic thrombocytopenic purpura (aTTP) in patients 12+ years old. Policy requires strict prior authorization with specific clinical criteria including thrombocytopenia, microangiopathic hemolytic anemia, and use in combination with plasma exchange and immunosuppressive therapy.
Action Required
Immediately: Billing team must implement prior authorization requirements for HCPCS code C9047 (caplacizumab-yhdp injection). Ensure prescriber is hematologist or has consulted with hematology specialist. Document all required clinical criteria including patient age 12+, thrombocytopenia with platelet count <100 x 109/L, microangiopathic hemolytic anemia confirmed by blood smear, and concurrent plasma exchange/immunosuppressive therapy. Claims without proper prior authorization and documentation will be denied.