CommercialPrior AuthLow impact
Treatment of Polyneuropathy of Hereditary Transthyretin-Mediated Amyloidosis
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Cardiology·Medical Policy
Effective date
Jan 31, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has established a new policy (L.5.01.608) declaring four expensive medications for hereditary transthyretin amyloidosis polyneuropathy as not medically necessary due to formulary alternatives. All services related to these medications require prior authorization approval through BCBSMS PA review process or will be considered not medically necessary.
Action Required
By January 31, 2025: Billing team must ensure prior authorization is obtained through BCBSMS PA review process before administering or billing for Onpattro (patisiran), Tegsedi (inotersen), Amvuttra (vutrisiran), and Wainua (eplontersen). Update billing system to flag HCPCS codes J0222 and J0225 as requiring PA. Claims for these medications and their administration will be denied without PA approval.