CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Leqvio (inclisiran)
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Endocrinology, Family Medicine +1 more·Medical Policy
Effective date
Dec 2, 2025
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Plan has updated their policy on Leqvio (inclisiran) injections, expanding the non-coverage from just heterozygous familial hypercholesterolemia to all hypercholesterolemia conditions. The medication and its administration are considered not medically necessary due to other covered treatment options being available.
Action Required
Immediately: Billing team must update system to flag HCPCS code J1306 (inclisiran injection) as non-covered for Mississippi State and School Employees' Health Plan members with any hypercholesterolemia diagnosis. Stop billing this code for affected members and inform providers that claims will be denied as not medically necessary. Update encounter forms to reflect this exclusion.