CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - 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
The Mississippi State and School Employees' Health Insurance Plan has updated their policy to classify Cabenuva (cabotegravir and rilpivirine) as not medically necessary for HIV treatment, citing that other covered alternatives are available. Both the medication and its administration services will not be covered under this plan.
Action Required
Immediately: Stop billing HCPCS code J0741 (injection, cabotegravir and rilpivirine, 2mg/3mg) for Mississippi State and School Employees' Health Insurance Plan members. Update billing system to flag this code as non-covered for this specific plan. Notify providers that Cabenuva injections and related administration services will be denied for these members and alternative HIV treatments should be considered.