CommercialPrior AuthLow impact
Zolgensma (onasemnogene abeparvovec)
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Pediatrics·Medical Policy
Effective date
Jun 3, 2025
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi updated their Zolgensma gene therapy policy with stricter medical necessity criteria, requiring genetic confirmation of SMA with bi-allelic SMN1 mutations and prohibiting concomitant use with Spinraza. The policy also added a new exclusion for Hood Packaging employees effective January 1, 2025.
Action Required
Immediately: Billing team must ensure prior authorization is obtained through BCBS Mississippi Case Management before administering Zolgensma. Update documentation requirements to include genetic confirmation of bi-allelic SMN1 mutations and verification that patient is not receiving Spinraza concurrently. Note exclusion for Hood Packaging covered members effective January 1, 2025.