CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Evenity (romosozumab-aqqg)
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Rheumatology, Orthopedics +3 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Plan now considers Evenity (romosozumab-aqqg) injections not medically necessary for osteoporosis treatment. All services related to delivery and administration of this medication will also be denied as not medically necessary.
Action Required
Immediately: Stop billing HCPCS code J3111 (romosozumab-aqqg injection) for Mississippi State and School Employees' Health Plan members. Update billing system to flag this code as non-covered for this specific plan. Notify providers that Evenity is considered not medically necessary and claims will be denied. Consider alternative osteoporosis treatments covered by the plan.