CommercialCoverageMedium impact
Akynzeo (netupitant and palonosetron)
Blue Cross & Blue Shield of Mississippi·MS · Oncology·Medical Policy
Effective date
Sep 9, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Akynzeo policy, changing language from 'treatment' to 'prevention' of chemotherapy-induced nausea and vomiting, but the drug remains considered not medically necessary. The policy continues to deny coverage for both oral and injection forms due to insufficient evidence of greater clinical benefit compared to other available treatment options.
Action Required
By September 9, 2025: Billing team must ensure HCPCS codes J1454 (injection) and J8655 (oral) for Akynzeo are flagged as non-covered in billing system for BCBS Mississippi members. For State Health Plan members, verify formulary coverage at https://www.dfa.ms.gov/cvs-caremark and submit prior authorization requests to pharmacy benefit manager before administration. Claims will be denied as not medically necessary without proper verification.