CommercialCoverageMedium impact
Treatment of Coronavirus Disease 2019 (COVID-19)
Blue Cross & Blue Shield of Mississippi·MS · Emergency Medicine, Critical Care, Pulmonology +4 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes coverage guidelines for COVID-19 treatments including Actemra, Olumiant, and Veklury (remdesivir) for both hospitalized and non-hospitalized patients. The policy specifies which COVID-19 treatments are considered medically necessary versus investigational, with hospitalized treatments included in DRG payments.
Action Required
Immediately: Billing team must verify formulary coverage for Actemra (tocilizumab), Olumiant (baricitinib), and Veklury (remdesivir) using patient's member ID before prescribing COVID-19 treatments. Update prior authorization workflows to ensure compliance with medical necessity criteria for hospitalized vs. non-hospitalized COVID-19 patients. Note that hospitalized COVID-19 drug treatments are bundled within hospital DRG payments.