CommercialPrior AuthLow impact
Nitisinone
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Pediatrics, Gastroenterology·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
BCBS Mississippi added coverage criteria for Harliku (nitisinone) to treat alkaptonuria in adults 18+ while maintaining existing prior authorization requirements for all nitisinone medications. All three nitisinone brands (Harliku, Nityr, Orfadin) remain non-formulary and require prior authorization with specific diagnostic confirmation.
Action Required
By January 1, 2026: Billing team must update prior authorization procedures to include new coverage criteria for Harliku (nitisinone) for alkaptonuria patients age 18+. Ensure staff verify elevated homogentisic acid levels or genetic variants in HGD gene for AKU diagnosis. Continue requiring prior auth for all nitisinone medications as they remain non-formulary.