CommercialPrior AuthLow impact
State and School Employees' Health Insurance Plan - Zolgensma (onasemnogene abeparvovec)
Blue Cross & Blue Shield of Mississippi·MS · Pediatrics, Neurology·Medical Policy
Effective date
Jun 3, 2025
We identified it
Jun 20, 2026
Summary
Updated policy for Zolgensma gene therapy clarifies the drug name to onasemnogene abeparvovec-xioi and adds a new requirement that patients cannot receive concomitant SMN modifying therapy like Spinraza. Prior authorization remains required for all cases meeting the strict criteria for pediatric SMA patients under 2 years old.
Action Required
By June 3, 2025: Billing team must update prior authorization documentation to verify patients are not receiving concomitant SMN modifying therapy (e.g., Spinraza). Update billing system to reflect updated drug name onasemnogene abeparvovec-xioi. Ensure all Zolgensma claims include confirmation of no concurrent SMN therapy or claims may be denied.