CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Treatment of Polyneuropathy of Hereditary Transthyretin-Mediated Amyloidosis
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Cardiology, Internal Medicine·Medical Policy
Effective date
Jan 31, 2025
We identified it
Jun 20, 2026
Summary
State and School Employees' Health Insurance Plan now considers Amvuttra (vutrisiran) and Onpattro (patisiran) not medically necessary for treating hereditary transthyretin-mediated amyloidosis polyneuropathy, as formulary alternatives are available. Claims for these medications and their administration will be denied.
Action Required
By January 31, 2025: Billing team must update system to flag HCPCS codes J0222 (patisiran) and J0225 (vutrisiran) as non-covered for State and School Employee plan members with polyneuropathy diagnosis. Verify formulary alternatives are available before scheduling these treatments. Claims for these codes will be denied as not medically necessary.