CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Monoclonal Antibodies for Treatment of Alzheimer’s Disease
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Internal Medicine, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
State and School Employees' Health Insurance Plan now considers two monoclonal antibody treatments for Alzheimer's disease (Kisunla and Leqembi) as not medically necessary. The policy also states that administration services for these medications will also be denied as not medically necessary.
Action Required
Immediately: Stop billing HCPCS codes J0174 (lecanemab-irmb injection) and J0175 (donanemab-azbt injection) for State and School Employees' Health Insurance Plan members. Update billing system to flag these codes as non-covered for this specific plan. Also avoid billing administration codes for these medications as they will be denied. Verify alternative covered Alzheimer's treatments in the plan formulary before prescribing.