CommercialPrior AuthMedium impact
Empaveli (pegcetacoplan)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Nephrology, Internal Medicine·Medical Policy
Effective date
Mar 20, 2025
We identified it
Jun 20, 2026
Summary
BCBSMS has established a new policy stating that Empaveli (pegcetacoplan) is considered not medically necessary for treating paroxysmal nocturnal hemoglobinuria (PNH) because other covered treatment options are available. Prior authorization is required for any services related to delivery or administration of this medication.
Action Required
Immediately: Billing team must verify prior authorization approval through BCBSMS PA review process before providing any Empaveli (pegcetacoplan) administration services. Update billing system to flag this medication for PA requirement. Claims for delivery or administration without PA approval will be denied as not medically necessary.