CommercialPrior AuthLow impact
State and School Employees' Health Insurance Plan - Revcovi (elapegademase-lvlr)
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Allergy & Immunology, Oncology +1 more·Medical Policy
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
New medical policy added for Revcovi (elapegademase-lvlr), a medication for treating ADA-SCID, a rare genetic immune deficiency. The policy establishes strict prior authorization criteria requiring genetic testing confirmation, specialist prescriber, and excludes patients with severe thrombocytopenia.
Action Required
By September 1, 2025: Billing team must implement prior authorization requirements for Revcovi (elapegademase-lvlr) using HCPCS J3590. Ensure specialist prescribers (immunologists, hematologist/oncologists) document ADA-SCID diagnosis with genetic testing results, platelet counts >50×109/L, and absence of FDA contraindications. Claims without proper prior authorization will be denied.