← Back to list
State and School Employees' Health Insurance Plan - Duchenne Muscular Dystrophy (DMD)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Elevidys (delandistrogene moxeparvovec-rokl) may be considered medically necessary as a single-dose intravenous infusion for Duchenne muscular dystrophy (DMD) when all listed criteria are met. Amondys 45 (casimersen), Exondys 51 (eteplirsen), Viltepso (viltolarsen), and Vyondys 53 (golodirsen) are considered investigational for DMD because there is insufficient evidence of clinical benefit. The most recent review, dated 02/24/2026, updated the Elevidys description to remove the non-ambulatory indication.
Get alerts when payers change rules like this one
We check Blue Cross & Blue Shield of Mississippi and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross & Blue Shield of Mississippi alertsPolicy Monitoring is free. No card required.
What to do
Action · 7 steps
01REQUIREMENTS: Billing team: Search the State Health Plan Medical Drug Formulary for drugs administered and billed through the medical setting before billing Elevidys (delandistrogene moxeparvovec-rokl).
02For Elevidys, the member must be more than 4 years of age at the time of infusion, must have a confirmed mutation in the DMD gene, must not have any deletion in exon 8 and/or exon 9 in the DMD gene, and must have a corticosteroid regimen for a minimum of 60 days initiated one day prior to infusion.
03The prescribed dosage must be within the program quantity limits based on the FDA approved labeled dosage.
04Length of approval is 1 infusion per lifetime (weight based).
05Amondys 45, Exondys 51, Viltepso, and Vyondys 53 are considered investigational for DMD, and their HCPCS codes J1426, J1427, J1428, J1429, and J3490 are listed in the policy's Investigational Codes table.
06Services related to delivery or administration of a medication determined to be not medically necessary will also be considered not medically necessary.
07Services not documented as medically necessary will not be paid.
Codes mentioned
J1413G71.01J1426J1427J1428J1429J3490
Original notice
State and School Employees' Health Insurance Plan - Duchenne Muscular Dystrophy (DMD)
bcbsms.com · Always check the source before changing claims.
Related changes
See all Blue Cross & Blue Shield of Mississippi changes →Duchenne Muscular Dystrophy (DMD)MediumNo effective date · Medical PolicyState and School Employees' Health Insurance Plan - Spravato (esketamine)HighEffective Jan 1, 2026 · Medical PolicyGenetic Testing for Duchenne and Becker Muscular DystrophyMediumNo effective date · Medical PolicyPulmonary Arterial HypertensionMediumEffective Oct 1, 2025 · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list