CommercialPrior AuthMedium impact
Onasemnogene Abeparvovec-xioi (Zolgensma®)
BCBS Tennessee·TN · Neurology, Pediatrics, General Practice·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee has established a new medical policy for Zolgensma (gene therapy for spinal muscular atrophy), requiring prior authorization with strict eligibility criteria including genetic testing, age restrictions (under 2 years), and specialist prescriber requirements. This policy will become effective June 30, 2026.
Action Required
Before June 30, 2026: Billing team must update prior authorization requirements for Zolgensma (onasemnogene abeparvovec-xioi) in system. Ensure providers understand that prescriptions must come from or be in consultation with SMA specialists, and that extensive documentation including genetic testing results, baseline lab values, and eligibility criteria must be submitted. Claims will require prior authorization approval before treatment.