CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Testosterone Replacement Therapy
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Urology, Family Medicine +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
The State and School Employees' Health Insurance Plan updated their testosterone replacement therapy policy to clarify that drug samples cannot be used to satisfy medical policy requirements and revised criteria for clinical documentation and testosterone level testing. The policy also added HCPCS code J1073 and specified that Azmiro (testosterone cypionate) is considered not medically necessary.
Action Required
By January 1, 2026: Billing team must update system to include new HCPCS code J1073 for testosterone replacement therapy. Providers must ensure prior authorization requests for testosterone therapy do not reference drug samples as qualifying therapy and must document two morning testosterone level tests (8-10 AM on different days) below normal lab ranges. Update encounter forms to remind providers that Azmiro injections are not covered as other formulary options exist.