CommercialCoverageLow impact
Enjaymo (sutimlimab-jome)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology, Internal Medicine·Medical Policy
Effective date
Dec 2, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their policy for Enjaymo (sutimlimab-jome), a treatment for cold agglutinin disease, maintaining that it is considered not medically necessary as other covered treatment options exist for this condition. The policy was reviewed and approved by their Pharmacy & Therapeutics Committee on December 2, 2025.
Action Required
Immediately: Billing team should be aware that HCPCS code J1302 (injection, sutimlimab-jome, 10 mg) will be denied as not medically necessary by BCBS Mississippi. If providers are considering this treatment for cold agglutinin disease patients, inform them that BCBS MS considers alternative covered treatments should be used first. Claims for J1302 will be denied without prior authorization approval.