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CommercialPrior AuthLow impact

Xyrem (sodium oxybate)

Blue Cross & Blue Shield of Mississippi·MS · Sleep Medicine, Neurology·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Blue Cross Blue Shield of Mississippi updated their prior authorization policy for Xyrem (sodium oxybate), a medication used to treat narcolepsy with cataplexy. The policy requires strict criteria including failed trials of other medications, REMS program enrollment, and weight-based dosing limits.

Action Required

Action needed
Immediately: Billing team should note that Xyrem (sodium oxybate) requires prior authorization for BCBS MS patients. Providers must ensure patients meet all criteria including failed trials of modafinil/armodafinil, methylphenidate/amphetamine stimulants, and antidepressants before prescribing. Verify REMS program enrollment and weight-based dosing limits. Prior auths approved for 6-month periods only.

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