CommercialPrior AuthMedium impact
Giant Cell Arteritis
Blue Cross & Blue Shield of Mississippi·MS · Rheumatology, Internal Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi updated their Giant Cell Arteritis policy, requiring prior authorization for Rinvoq (upadacitinib) and Tyenne (tocilizumab-aazg), while completely removing coverage for Actemra (tocilizumab) and Tofidence (tocilizumab-bavi) from all formularies. The policy includes strict diagnostic criteria and specialist consultation requirements.
Action Required
Immediately: Billing team must flag all Giant Cell Arteritis patients on tocilizumab medications for prior authorization review. Stop processing claims for Actemra and Tofidence as they are no longer covered. Update prior authorization tracking system to require specialist consultation documentation and specific lab values (ESR ≥30 mm/hr or CRP ≥1 mg/dL) for Rinvoq and Tyenne approvals. Notify rheumatologists and other specialists that samples cannot be used to satisfy medical policy requirements.