CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Tzield (teplizumab-mzwv)
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Pediatrics, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Insurance Plan now considers Tzield (teplizumab-mzwv) injection not medically necessary for delaying Stage 3 type 1 diabetes onset. All services related to delivery and administration of this medication are also considered not medically necessary and will not be covered.
Action Required
Immediately: Billing team must update system to flag HCPCS code J9381 (Tzield injection) as not covered for Mississippi State and School Employees' Health Insurance Plan members. Stop submitting claims for this code and related administration services for these members. Notify providers that Tzield is considered not medically necessary and claims will be denied.