CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Duchenne Muscular Dystrophy (DMD)
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Pediatrics·Medical Policy
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Plan now covers Elevidys (delandistrogene moxeparvovec-rokl) as medically necessary for treating Duchenne muscular dystrophy in ambulatory patients over 4 years old with confirmed DMD gene mutations, while four other DMD drugs remain investigational. The policy includes strict criteria including 60-day corticosteroid pre-treatment and lifetime limits to one infusion.
Action Required
Immediately: Update billing system to flag J1413 (Elevidys) as covered for Mississippi state employees when all medical necessity criteria are met, including patient age >4 years, confirmed DMD gene mutation without exon 8/9 deletions, and 60-day corticosteroid pre-treatment. Continue marking J1426, J1427, J1428, J1429 as investigational/non-covered. Add G71.01 as acceptable diagnosis code for covered Elevidys treatment.