CommercialPrior AuthLow impact
Apomorphine
Blue Cross & Blue Shield of Mississippi·MS · Neurology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBSMS updated their apomorphine (Apokyn/Onapgo) policy for advanced Parkinson's disease treatment. Apokyn requires prior authorization with specific criteria including age ≥18, neurologist diagnosis, current levodopa therapy, and no contraindicated medications. Onapgo is considered not medically necessary.
Action Required
Immediately: Billing team must verify prior authorization is obtained before billing for apomorphine (Apokyn) injections for Parkinson's patients. Ensure patients meet all criteria: ≥18 years old, neurologist-diagnosed advanced Parkinson's with off episodes, on levodopa plus another Parkinson's medication, no 5HT3 antagonist drugs, and within FDA dosage limits. Do not bill for Onapgo as it's considered not medically necessary. Claims without proper prior auth will be denied.