CommercialCoverageLow impact
Oxlumo (lumasiran)
Blue Cross & Blue Shield of Mississippi·MS · Nephrology, Pediatrics, Endocrinology·Medical Policy
Effective date
Sep 15, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has issued a new policy declaring Oxlumo (lumasiran) injection as not medically necessary for treating primary hyperoxaluria type 1, citing that other covered treatment options are available. Claims for this medication and its administration will be denied.
Action Required
Immediately: Billing team must flag HCPCS code J0224 (lumasiran injection) as non-covered for BCBS Mississippi plans. Update billing system to prevent claims submission and alert providers that this medication is considered not medically necessary. Advise providers to use alternative covered treatments for primary hyperoxaluria type 1 patients.