CommercialPrior AuthMedium impact
NSAIDs
Blue Cross & Blue Shield of Mississippi·MS · Rheumatology, Orthopedics, Pain Management +2 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their NSAIDs policy for Nalfon (fenoprofen calcium), requiring prior authorization and failure of three covered NSAIDs before approval. The policy removes coverage for tolmetin sodium and clarifies that sample usage doesn't count toward therapy requirements.
Action Required
Immediately: Update prior authorization protocols for Nalfon (fenoprofen calcium) prescriptions. Billing team must verify patients have failed three covered NSAIDs before submitting PA requests. Providers must document contraindications and ensure dosing is within FDA limits. Claims without proper prior authorization will be denied.