CommercialPrior AuthMedium impact
Fabhalta (iptacopan)
Blue Cross & Blue Shield of Mississippi·MS · Nephrology, Hematology, Oncology·Medical Policy
Effective date
Mar 20, 2025
We identified it
Jun 20, 2026
Summary
BCBSMS has issued a new policy declaring Fabhalta (iptacopan) not medically necessary for IgA nephropathy treatment and stating other covered options exist for PNH treatment. Prior authorization through BCBSMS PA review process is required for any services related to this medication.
Action Required
By March 20, 2025: Billing team must update systems to require BCBSMS prior authorization for all Fabhalta (iptacopan) prescriptions and related services. Providers should be notified that Fabhalta is considered not medically necessary for IgA nephropathy and alternative covered treatments should be used for PNH. Claims for Fabhalta services without PA approval will be denied as not medically necessary.