CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Leukine (sargramostim)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology·Medical Policy
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Insurance Plan updated their Leukine (sargramostim) policy to clarify that drug samples cannot be used to satisfy medical policy requirements and revised the medically necessary criteria language from 'will be approved' to 'may be considered medically necessary'.
Action Required
Immediately: Billing team must ensure prior authorization requests for Leukine (sargramostim) injection J2820 do not reference drug samples as current therapy. Update authorization forms and provider guidance to emphasize established therapy documentation is required. Verify all claims meet the revised medically necessary criteria before submission.