CommercialPrior AuthMedium impact
State and School Employees' Health Insurance Plan - Crysvita (burosumab-twza)
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Nephrology, Rheumatology +2 more·Medical Policy
We identified it
Jun 20, 2026
Summary
New policy establishes coverage criteria for Crysvita (burosumab-twza) for treating X-linked hypophosphatemia and tumor-induced osteomalacia, requiring prior authorization with specific diagnostic criteria, lab values, and specialist involvement. Initial approvals are for 6 months, renewals for 12 months with documented clinical improvement.
Action Required
Immediately: Billing team must implement prior authorization requirements for Crysvita (burosumab-twza) claims. Update system to verify all criteria are met including: patient age requirements, confirmed diagnosis with specific FGF23 levels or genetic testing, baseline phosphorus levels, specialist prescriber involvement, and contraindication screening. Create documentation checklist for providers to ensure all required clinical criteria and lab values are documented before administration. Claims will be denied without proper prior authorization.