CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Kimyrsa (oritavancin)
Blue Cross & Blue Shield of Mississippi·MS · Infectious Disease, Dermatology, Emergency Medicine +2 more·Medical Policy
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
The State and School Employees' Health Insurance Plan has added a new policy effective November 1, 2025, declaring Kimyrsa (oritavancin) as not medically necessary for treating bacterial skin infections. Claims for CPT code J2406 and related administration services will be denied as the plan considers other covered treatment options sufficient.
Action Required
By November 1, 2025: Billing team must update system to flag CPT code J2406 (oritavancin injection) as non-covered for State and School Employees' Health Plan members. Alert providers that Kimyrsa and its administration will be denied. Verify alternative covered antibiotics are available on the plan formulary before treating bacterial skin infections.