CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - Enjaymo (sutimlimab-jome)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology, Rheumatology·Medical Policy
Effective date
Dec 16, 2024
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Plan now considers Enjaymo (sutimlimab-jome) not medically necessary for cold agglutinin disease treatment, stating other covered treatment options are available. Claims for this medication and its administration will be denied.
Action Required
Immediately: Billing team must flag HCPCS code J1302 (sutimlimab-jome injection) as non-covered for Mississippi State and School Employees' Health Plan members. Update billing system to prevent claims submission for this code. Notify providers that Enjaymo is considered not medically necessary and claims will be denied.