CommercialPrior AuthLow impact
State and School Employees' Health Insurance Plan - Hereditary Angioedema (HAE)
Blue Cross & Blue Shield of Mississippi·MS · Allergy & Immunology, Emergency Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
New policy establishes specific medical necessity criteria and prior authorization requirements for hereditary angioedema (HAE) medications including Berinert, Cinryze, Kalbitor, and Ruconest. Berinert is designated as preferred, while other HAE medications are considered non-preferred or not medically necessary.
Action Required
Immediately: Billing team must implement prior authorization requirements for all HAE medications (Berinert, Cinryze, Kalbitor, Ruconest) before billing. Verify specialist involvement (allergist/immunologist) and ensure proper diagnosis documentation with C1-INH testing results. Update billing system to flag these medications for prior auth review. Claims will be denied without proper authorization.