CommercialPrior AuthMedium impact
Pulmozyme (dornase alfa)
Blue Cross & Blue Shield of Mississippi·MS · Pulmonology, Pediatrics, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBSMS updated their Pulmozyme (dornase alfa) policy, clarifying that drug samples cannot be used to satisfy medical policy requirements and refining contraindication and dosage criteria for prior authorization. The policy still requires prior authorization for cystic fibrosis patients with quantity limits of 60 ampules per month.
Action Required
Immediately: Billing team must ensure prior authorization requests for Pulmozyme (dornase alfa) do not reference drug samples as justification for therapy. Update prior auth templates to document contraindication screening and FDA-approved dosing. For State Health Plan members, perform formulary search at https://www.dfa.ms.gov/cvs-caremark and submit PA requests to their Pharmacy Benefit Manager instead.