CommercialCoverageMedium impact
Evenity (romosozumab-aqqg)
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Rheumatology, Orthopedics +2 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Evenity (romosozumab-aqqg) policy to clarify that both the medication and its administration services are considered not medically necessary for osteoporosis treatment. The policy now explicitly states that delivery and administration services will also be denied when the medication itself is deemed not medically necessary.
Action Required
Immediately: Stop billing HCPCS code J3111 (romosozumab-aqqg injection) and any related administration codes for BCBS Mississippi patients, as claims will be denied. Exception: State Health Plan employees may have coverage through their pharmacy benefit manager - verify formulary status at https://www.dfa.ms.gov/cvs-caremark before billing. Update billing system to flag Evenity injections for coverage verification.