CommercialPrior AuthLow impact
Lumasiran (Oxlumo®)
BCBS Tennessee·TN · Nephrology, Urology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee is implementing a new medical policy for Lumasiran (Oxlumo®) for primary hyperoxaluria type 1 treatment, requiring prior authorization with genetic testing confirmation and specialist prescribing. The policy establishes comprehensive coverage criteria including molecular testing requirements and excludes combination with certain other medications.
Action Required
By July 31, 2026: Billing team must implement prior authorization requirements for Lumasiran (Oxlumo®) claims. Ensure genetic testing documentation (AGXT gene variants or AGT enzyme analysis) and baseline oxalate levels are collected before submission. Verify prescriber is a geneticist, nephrologist, or urologist. Update prior auth request forms to include required molecular testing results and lab values.