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Impavido (miltefosine)

Blue Cross & Blue Shield of Mississippi·MS · Infectious Disease, Family Medicine, Internal Medicine·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

BCBS Mississippi updated their medical policy for Impavido (miltefosine), a drug used to treat leishmaniasis, requiring prior authorization and specific criteria including age ≥12 years, weight ≥30kg, documented diagnosis, and special contraception requirements for females of reproductive potential. The policy includes specific dosing guidelines and 28-day approval lengths.

Action Required

Action needed
Immediately: Billing team must ensure prior authorization is obtained before prescribing Impavido (miltefosine) for any BCBS Mississippi patients. Providers must verify patient meets all criteria: age ≥12 years, weight ≥30kg, documented leishmaniasis diagnosis, no contraindications, and for females of reproductive potential - negative pregnancy test and contraception counseling. Update encounter forms to include these requirements. Claims will be denied without proper prior authorization.
Impavido (miltefosine) | Blue Cross & Blue Shield of Mississippi | PolicyChanges.app