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CommercialCoverageMedium impact

State and School Employees' Health Insurance Plan - Rolvedon (eflapegrastim-xnst)

Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Mississippi State and School Employees' Health Insurance Plan now considers Rolvedon (eflapegrastim-xnst) injections NOT medically necessary due to available formulary alternatives. Claims for HCPCS J1449 will be denied, and administration services related to this medication will also be denied.

Action Required

Action needed
Immediately: Update billing system to flag HCPCS J1449 (eflapegrastim-xnst injections) as non-covered for Mississippi State and School Employees' Health Plan members. Verify formulary alternatives are available before administering G-CSF treatments to cancer patients. Claims for J1449 and related administration codes will be denied for this specific plan.

Affected Billing Codes

J1449

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