CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - Actimmune (interferon gamma-1b)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Endocrinology, Rheumatology +1 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
The State and School Employees' Health Insurance Plan updated their policy for Actimmune (interferon gamma-1b) with revised approval criteria, corrected terminology from osteoporosis to osteopetrosis, and updated ICD-10 diagnosis codes. The policy now specifies that drug samples cannot be used to satisfy medical necessity requirements and requires specialist consultation.
Action Required
By October 1, 2025: Billing team must update diagnosis coding to use new ICD-10 code D71.8 instead of deleted code D71 for functional disorders of polymorphonuclear neutrophils. Ensure prior authorization requests for Actimmune (J9216) include specialist consultation documentation and cannot reference drug samples as current therapy. Verify osteopetrosis diagnoses use correct ICD-10 code Q78.2.