CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Erythropoiesis-Stimulating Agents
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology, Nephrology +2 more·Medical Policy
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
This is a new medical policy for State and School Employees' Health Insurance Plan covering erythropoiesis-stimulating agents (ESAs) including Aranesp, Epogen, Procrit, and Retacrit. The policy defines medical necessity criteria for treating anemia related to chronic kidney disease, chemotherapy, HIV therapy, and surgical procedures, with recent updates adding new ICD-10 diagnosis codes effective October 1, 2024.
Action Required
Immediately: Billing team must verify coding system includes the new ICD-10 diagnosis codes added effective October 1, 2024 for lymphoma and hematologic conditions. For State and School Employees' Health Insurance Plan members receiving ESAs, ensure claims include appropriate medical necessity documentation per policy criteria. Check with State Health Plan formulary at https://www.dfa.ms.gov/cvs-caremark for self-administered drugs that may require prior authorization through the pharmacy benefit manager instead of medical benefit.