MedicaidCoverageHigh impact
Updates on Lupron Depot Injections for State Health Plan Members
BlueCross BlueShield of South Carolina·SC · Oncology, Endocrinology, Urology +1 more·Benefits and Eligibility
Effective date
Jan 1, 2026
We identified it
Aug 11, 2026
Summary
Effective January 1, 2026, Lupron Depot injections transitioned from pharmacy benefit coverage to medical benefit coverage for State Health Plan members. Prior authorization remains required and must now be submitted through MBMNow via My Insurance Insurance Manager℠. Billing team must route all Lupron Depot claims to the medical benefit and obtain prior authorization before administration.
Action Required
Immediately: Billing team must reconfigure claim routing in billing software to submit Lupron Depot (HCPCS J9218, J9217) to the medical benefit instead of the pharmacy benefit for all State Health Plan members. Before administering Lupron Depot: Clinical staff and providers must submit prior authorization requests through MBMNow (accessible via My Insurance Insurance Manager℠) before each injection—do not process claims without authorization approval. Update encounter templates and pre-visit checklists to flag Lupron Depot as requiring prior auth verification. Failure to route through medical benefit or obtain prior authorization will result in claim denials.