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Blue Cross & Blue Shield of MississippiCommercial · Prior Auth · Medical Policy · Infectious DiseaseMedium impact

Fetroja (cefiderocol sulfate tosylate)

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Fetroja (cefiderocol sulfate tosylate) requires prior authorization. It may be considered medically necessary for individuals older than 18 with complicated urinary tract infection, including pyelonephritis, caused by listed susceptible Gram-negative organisms, or with hospital-acquired or ventilator-associated bacterial pneumonia caused by listed susceptible organisms. Culture and sensitivity testing must have identified the pathogen and demonstrated susceptibility to the requested medication. The individual must have limited or no alternative treatment options and no FDA-labeled contraindication, and the dosage must be within program quantity limits. Length of approval is up to 14 days. The 12/02/2025 review added the statement that prior authorization is required and that samples do not count as current or stable therapy.

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What to do

Action · 6 steps
01Billing team: Get prior authorization for Fetroja (J0699).
02Attach culture and sensitivity testing results that identify the pathogen and show susceptibility to Fetroja, because documentation is required.
03Confirm the individual has limited or no alternative treatment options and no FDA-labeled contraindication to Fetroja.
04Confirm the prescribed dosage is within program quantity limits based on FDA approved labeled dosage.
05Samples do not count as current or stable therapy.
06Services related to delivery and/or administration of a medication determined to be not medically necessary will also be considered not medically necessary.

Codes mentioned

J0699

Original notice

Fetroja (cefiderocol sulfate tosylate)
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Fetroja (cefiderocol sulfate tosylate)MediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesInfectious DiseaseCode J0699

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