CommercialCoverageHigh impact
State and School Employees' Health Insurance Plan - New Drug Approvals and Newly Approved Indications for Currently Available Medications
Blue Cross & Blue Shield of Mississippi·MS·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi (State and School Employees' Health Insurance Plan) has established a policy that automatically considers all new-to-market drugs, newly FDA-approved medications, and new indications for existing medications as non-formulary and not medically necessary until reviewed by their P&T Committee. This affects billing for drug administration services as well as the medications themselves.
Action Required
Immediately: Billing team must verify formulary status for any new-to-market or newly FDA-approved medications before billing. Check the State Health Plan Medical Drug Formulary before submitting claims for drug administration services. Expect denials for new drugs and new indications until BCBSMS P&T Committee completes their review and updates their formulary. Implement prior authorization workflow for all new medications under this plan.