CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - Niktimvo (axatilimab-csfr)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Hematology·Medical Policy
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Insurance Plan has added a new policy effective September 1, 2025, that considers Niktimvo (axatilimab-csfr) not medically necessary for treating chronic graft-versus-host disease. This drug and its administration services will not be covered because other covered treatment options are available.
Action Required
By September 1, 2025: Billing team must update system to flag HCPCS code J9038 (axatilimab-csfr injection) as non-covered for Mississippi State and School Employees' Health Insurance Plan members. Notify providers that Niktimvo and related administration services will be denied as not medically necessary. Update encounter forms to alert staff about non-coverage.