CommercialPrior AuthLow impact
State and School Employees' Health Insurance Plan - Givlaari (givosiran)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Gastroenterology·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield Mississippi updated their medical policy for Givlaari (givosiran) treatment of acute hepatic porphyria, establishing specific prior authorization criteria including age requirements, diagnostic confirmation, and evidence of active disease within 6 months. The policy requires specialist consultation and has strict renewal criteria with documented clinical improvement.
Action Required
Billing team must ensure prior authorization is obtained for J0223 (givosiran injection) before billing. Verify patients meet all criteria: age 18+, confirmed AHP diagnosis with elevated PBG/ALA or genetic mutation, evidence of 2+ attacks or 1 severe CNS attack in past 6 months, and specialist prescription. Document all requirements as claims without proper authorization will be denied.