CommercialPrior AuthMedium impact
Lysosomal Storage Disorders
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Hematology, Pediatrics +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS MS has updated their medical policy for Lysosomal Storage Disorders, establishing detailed prior authorization requirements for 15 specialized enzyme replacement therapies including Cerezyme, Fabrazyme, and Aldurazyme. The policy requires specific diagnostic criteria, age requirements, specialist consultation, and documented clinical parameters for approval of these high-cost medications.
Action Required
Immediately: Billing team must implement prior authorization processes for all 15 listed lysosomal storage disorder medications (Aldurazyme, Cerdelga, Cerezyme, Elaprase, Elelyso, Elfabrio, Fabrazyme, Kanuma, Lumizyme, Naglazyme, Nexviazyme, Opfolda, Pombiliti, Vpriv, Zavesca). Update encounter forms to remind providers to obtain specialist consultation and document required clinical parameters including enzyme levels, genetic testing results, and organ measurements. Verify formulary coverage for each patient's specific benefit plan before prescribing. Claims without proper prior authorization will be denied.