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Interleukin-5 Antagonist Monoclonal Antibodies
Effective date
Jan 1, 2027
Identified
Jun 20, 2026
Summary
Exdensur (depemokimab-ulaa) is not covered on any BCBSMS Formulary. Cinqair (reslizumab) will no longer be covered effective 01/01/2027, and Fasenra (benralizumab) is medically necessary when the listed criteria are met. Prior authorization is required for these medications, and the length of approval is 12 months.
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What to do
Action · 8 steps
01Before 01/01/2027: Cinqair (reslizumab, HCPCS J2786) will no longer be covered.
02Exdensur (depemokimab-ulaa, HCPCS J2361) is not covered on any BCBSMS Formulary, so perform a formulary drug search on the member ID to confirm the drug is covered under the member's benefit plan.
03Prior authorization is required, and all listed criteria must be met for initial approval, which is for 12 months.
04The use of samples by an individual will not be considered current or stable therapy.
05For a Nucala vial or Fasenra syringe to be administered by a healthcare professional, the member must have tried the self-administered product unsuccessfully or be clinically unable to use it.
06BCBSMS may request medical records for determination of medical necessity, and letters of support are not sufficient unless all specific information needed to make the determination is included.
07Services related to delivery or administration of a medication that were not approved through the BCBSMS PA review process will be considered not medically necessary.
08Medication failure means disease progression at generally accepted doses for more than 3 months of use, and BCBSMS determines medication trials and adherence from pharmacy claims data over the preceding twelve months.
Codes mentioned
J0517J2182J2786J2361
Original notice
Interleukin-5 Antagonist Monoclonal Antibodies
bcbsms.com · Always check the source before changing claims.
Related changes
See all Blue Cross & Blue Shield of Mississippi changes →Interleukin-5 Antagonist Monoclonal Antibodies - Revised Policy Effective Date: 01/01/2027 [Notice Date: 11/01/2026]MediumEffective Jan 1, 2027 · Medical PolicyState and School Employees' Health Insurance Plan - Interleukin-5 Antagonist Monoclonal AntibodiesHighEffective Nov 1, 2026 · Medical PolicyProvider-Administered Drugs Coding PolicyHighNo effective date · CodingBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list