CommercialCoverageMedium impact
ACL Inhibitors and Combinations
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Internal Medicine, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their policy stating that Nexletol (bempedoic acid) and Nexlizet (bempedoic acid/ezetimibe) are considered not medically necessary as other treatment options are covered on formulary. The policy was recently revised to update drug indications and remove previous language about treatment guidelines.
Action Required
Immediately: Billing team must verify formulary coverage for all patients before prescribing Nexletol or Nexlizet by performing formulary drug searches using patient member IDs. For State Health Plan members, check coverage at https://www.dfa.ms.gov/cvs-caremark and submit Prior Authorization Requests to the Pharmacy Benefit Manager. Claims for these medications will likely be denied as not medically necessary.