CommercialPrior AuthMedium impact
Hereditary Angioedema (HAE)
Blue Cross & Blue Shield of Mississippi·MS · Allergy & Immunology, Emergency Medicine, Internal Medicine·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Hereditary Angioedema (HAE) policy requiring prior authorization for all HAE medications including Andembry, Berinert, Firazyr, and others. The policy specifies detailed coverage criteria for both acute treatment and prophylactic therapy, with some medications considered not medically necessary due to formulary alternatives.
Action Required
Before April 1, 2026: Billing team must implement prior authorization requirements for all HAE medications (Andembry, Berinert, Cinryze, Dawnzera, Ekterly, Firazyr, Haegarda, Kalbitor, Orladeyo, Ruconest, Takhzyro, Sajazir). Update system to verify formulary coverage via member ID search before prescribing. Ensure providers obtain specialist consultation or are specialists themselves (allergist/immunologist). Claims without proper prior auth will be denied.