CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Giant Cell Arteritis
Blue Cross & Blue Shield of Mississippi·MS · Rheumatology, Internal Medicine·Medical Policy
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Effective January 1, 2025, the State and School Employees' Health Insurance Plan will only cover Tyenne (tocilizumab-aazg) for giant cell arteritis treatment, while removing coverage for Actemra (tocilizumab) and Tofidence (tocilizumab-bavi). The policy requires strict prior authorization criteria including specialist consultation, current glucocorticoid therapy, and specific diagnostic requirements.
Action Required
By January 1, 2025: Billing team must update system to block claims for Actemra (J3262) and Tofidence (Q5133) for giant cell arteritis and ensure prior authorization is obtained for Tyenne (Q5135) before administration. Update encounter forms to remind providers that only Tyenne is covered and requires specialist consultation documentation. Claims for non-covered tocilizumab products will be denied.