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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · Psychiatry, Emergency Medicine, Internal MedicineMedium impact

State and School Employees' Health Insurance Plan - Igalmi (dexmedetomidine)

Act
immediately
Effective date
Nov 15, 2025
Identified
Jun 20, 2026

Summary

Blue Cross Blue Shield of Mississippi has added a new policy declaring Igalmi (dexmedetomidine) as not medically necessary for treating agitation in schizophrenia or bipolar disorder, with HCPCS code J1105 specifically listed as non-covered. Claims for this medication will be denied unless prior authorization is obtained through BCBSMS.

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What to do

immediately · 3 steps
01Billing team must flag HCPCS code J1105 (dexmedetomidine oral) as requiring prior authorization through BCBSMS PA review process for Mississippi State and School Employees' Health Insurance Plan members.
02Update billing system to prevent claims submission without prior auth approval.
03Notify providers that Igalmi is considered not medically necessary and alternative covered options should be used for agitation treatment.

Codes mentioned

J1105

Original notice

State and School Employees' Health Insurance Plan - Igalmi (dexmedetomidine)
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Igalmi (dexmedetomidine)MediumNo effective date · 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 changesPsychiatryEmergency MedicineInternal MedicineCode J1105

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