CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - Scenesse (afamelanotide)
Blue Cross & Blue Shield of Mississippi·MS · Dermatology·Medical Policy
Effective date
Feb 24, 2026
We identified it
Jun 20, 2026
Summary
State and School Employees' Health Insurance Plan has updated their policy to classify Scenesse (afamelanotide) implants as not medically necessary for treating erythropoietic protoporphyria (EPP). Claims for this medication and its administration will be denied as supportive measures are considered the standard of care.
Action Required
By February 24, 2026: Billing team must update system to flag HCPCS code J7352 (afamelanotide implant) as non-covered for State and School Employees' Health Insurance Plan members. Inform providers that Scenesse claims will be denied and supportive measures should be documented as treatment for EPP patients.