CommercialPrior AuthMedium impact
Treatment of Metabolic Dysfunction-Associated Steatohepatitis (MASH)
Blue Cross & Blue Shield of Mississippi·MS · Gastroenterology, Internal Medicine, Endocrinology·Medical Policy
Effective date
Jan 15, 2025
We identified it
Jun 20, 2026
Summary
BCBSMS has established a new policy classifying Rezdiffra (resmetirom) for MASH treatment as investigational with insufficient evidence of clinical benefit. The drug requires prior authorization through BCBSMS PA review process, and services related to delivery/administration without PA approval will be denied as not medically necessary.
Action Required
Immediately: Billing team must verify prior authorization approval through BCBSMS PA review process before billing any services related to Rezdiffra (resmetirom) delivery or administration for MASH treatment. Update system to flag this drug as requiring PA. Claims for related services without PA approval will be denied as not medically necessary.