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Gene Therapy for Inherited Retinal Dystrophy
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi has established coverage policy for gene therapy treatment Luxturna (voretigene neparvovec-rzyl) for inherited retinal dystrophy caused by RPE65 gene variants. The policy requires prior authorization and genetic testing confirmation, with specific exclusions including Hood Packaging members effective 01/01/2025.
Action Required
Immediately: For any patients requiring Luxturna gene therapy, billing team must obtain prior authorization through Case Management from Blue Cross & Blue Shield of Mississippi before treatment initiation. Ensure genetic testing documentation confirms biallelic RPE65 pathogenic variants and patient meets all eligibility criteria including age requirements (≥3 years, <65 years) and viable retinal cells. Note: Hood Packaging members are excluded from coverage effective 01/01/2025.