CommercialCoverageLow impact
Leqvio (inclisiran)
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Endocrinology, Family Medicine +1 more·Medical Policy
Effective date
Dec 2, 2024
We identified it
Jun 20, 2026
Summary
BCBSMS updated their policy on Leqvio (inclisiran) injections, changing the covered condition from 'primary hyperlipidemia' to the broader term 'hypercholesterolemia' but maintaining that the medication is considered not medically necessary since other covered treatment options exist. The billing code J1306 remains classified as not medically necessary.
Action Required
Immediately: Billing team should verify that HCPCS code J1306 (inclisiran injection) continues to be flagged as not medically necessary in billing system for BCBSMS claims. Ensure staff understand that this medication requires prior authorization through BCBSMS PA review process and that administration services will be denied if medication is not approved.