CommercialCoverageLow impact
Cabenuva (cabotegravir and rilpivirine)
Blue Cross & Blue Shield of Mississippi·MS · Infectious Disease, Internal Medicine, Family Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their policy for Cabenuva (HIV treatment injectable), continuing to classify it as not medically necessary since other covered alternatives are available. The policy maintains that services related to delivery/administration without prior authorization approval will be denied.
Action Required
Immediately: Billing team should verify that any Cabenuva (J0741) claims for BCBS Mississippi patients have completed prior authorization through BCBSMS PA review process before billing. Claims without PA approval will be denied as not medically necessary. For State Health Plan members, check formulary at https://www.dfa.ms.gov/cvs-caremark and submit PA requests to pharmacy benefit manager.