CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Recarbrio (imipenem-cliastatin-relebactam)
Blue Cross & Blue Shield of Mississippi·MS · Infectious Disease, Critical Care, Pulmonology +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Mississippi's State and School Employees' Health Insurance Plan has updated their policy to consider Recarbrio (imipenem-cilastatin-relebactam) not medically necessary for all approved indications, including hospital-acquired pneumonia and complicated infections. The drug is only covered when patients have limited or no alternative treatment options for certain conditions.
Action Required
Immediately: Billing team must update system to flag HCPCS code J0742 (Recarbrio injection) as requiring documentation of limited or no alternative treatment options for complicated UTI and intra-abdominal infections. For hospital-acquired pneumonia and ventilator-associated pneumonia, claims will likely be denied as not medically necessary. Providers must document exhaustion of covered alternatives before using Recarbrio.