CommercialPrior AuthMedium impact
Interstitial Lung Disease
Blue Cross & Blue Shield of Mississippi·MS · Pulmonology, Rheumatology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has updated their medical policy for interstitial lung disease medications, requiring prior authorization for Esbriet, Ofev, and Tyenne with specific clinical criteria. Actemra and Tofidence are not covered on any BCBSMS formulary.
Action Required
Immediately: Billing team must verify prior authorization is obtained before prescribing or administering Esbriet (pirfenidone), Ofev (nintedanib), or Tyenne (tocilizumab-aazg) for interstitial lung disease patients. Update encounter forms to alert providers that Actemra and Tofidence are not covered. Perform formulary drug search on patient's member ID before prescribing. Claims will be denied without proper prior authorization.