CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Tecelra (afamitresgene autoleucel)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology·Medical Policy
Effective date
Jun 3, 2025
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Plan has issued a new policy classifying Tecelra (afamitresgene autoleucel), a CAR-T cell therapy for synovial sarcoma, as investigational and not medically necessary. This means claims for this treatment and its administration will be denied.
Action Required
By June 3, 2025: Billing team must update system to flag HCPCS code Q2057 (afamitresgene autoleucel) as non-covered for Mississippi State and School Employees' Health Plan. Notify oncology providers that this treatment is considered investigational and claims will be denied. Review any pending or future synovial sarcoma cases requiring this therapy for alternative coverage options.