CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Ryzneuta (efbemalenograstim alfa-vuxw)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology·Medical Policy
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Insurance Plan has added a new policy effective October 15, 2025, declaring Ryzneuta (efbemalenograstim alfa-vuxw) as not medically necessary for preventing chemotherapy-induced febrile neutropenia. Claims for this medication and its administration will be denied as covered alternatives exist.
Action Required
Immediately: Billing team must flag HCPCS code J9361 (efbemalenograstim alfa-vuxw injection) as non-covered for Mississippi State and School Employees' Health Insurance Plan members. Update billing system to prevent submission of claims for this code. Providers should be notified to use covered alternatives for chemotherapy-induced neutropenia prevention. Claims submitted will be denied.