CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - 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
Mississippi State and School Employees' Health Plan has added a new policy designating Oxlumo (lumasiran) injection as not medically necessary for primary hyperoxaluria type 1 treatment, citing availability of other covered treatment options. 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 Mississippi State and School Employees' Health Plan members. Update billing system to alert staff that claims for this code will be denied. Verify alternative covered treatments are available before scheduling patients with primary hyperoxaluria type 1.