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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · DermatologyMedium impact

State and School Employees' Health Insurance Plan - Chronic Plaque Psoriasis

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Avsola and Renflexis were added as medical covered agents on 11/01/2026, alongside Cimzia, Ilumya, Inflectra, infliximab and Remicade, and these medical covered agents have no step therapy requirement. Initial approval requires an FDA-labeled indication for the requested agent, plaque psoriasis involving at least 10% of total body surface area or less than 10% with sensitive areas involved, and either failure of a conventional agent or an FDA-labeled contraindication or hypersensitivity to all conventional agents. Approval lasts 12 months, and renewal requires prior approval through BCBSMS review, clinical improvement, and no FDA-labeled contraindication.

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What to do

Action · 10 steps
01Billing team: Use the Covered Codes table when billing these agents: J0717 (Cimzia), J1745 (Remicade, unbranded infliximab), J3245 (Ilumya), Q5103 (Inflectra), Q5104 (Renflexis) and Q5121 (Avsola).
02Q5104 and Q5121 were added to the Covered Codes table with the 11/01/2026 update.
03Providers: Confirm that the requested agent has an FDA-labeled indication and that the individual has an intolerance to conventional agents, since the 11/01/2026 update added these criteria.
04Providers: Confirm that the prescriber is or has consulted with a specialist, such as a board certified dermatologist.
05Providers: Confirm the individual was tested for latent TB when required by the prescribing information, and that latent TB therapy was begun if the test was positive.
06Samples or vouchers/coupons are not approvable as current treatment with the requested agent, and the use of samples is not considered current or stable therapy.
07The prescribed dosage must be within the program quantity limits based on FDA approved labeled dosage.
08Services related to delivery and/or administration of a medication determined to be not medically necessary will also be considered not medically necessary.
09For self-administered drugs, perform a formulary drug search at https://www.dfa.ms.gov/cvs-caremark and submit any required Prior Authorization Requests to the Plan's Pharmacy Benefit Manager.
10Services related to delivery and/or administration of a self-administered drug are not covered under the medical benefit.

Codes mentioned

J0717J1745J3245Q5103Q5104Q5121L40.0

Original notice

State and School Employees' Health Insurance Plan - Chronic Plaque Psoriasis
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Anti-Rheumatic BiologicalsHighNo effective date · Medical PolicyState and School Employees' Health Insurance Plan - Biosimilar MedicationsHighEffective Jan 1, 2027 · Medical PolicyChronic Plaque PsoriasisHighEffective Nov 1, 2026 · Medical PolicyAnti-Rheumatic BiologicalsHighEffective Nov 1, 2026 · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesDermatologyCode J0717Code J1745Code J3245Code Q5103Code Q5104Code Q5121Code L40.0

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