33 commercial payer policies list J0224. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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33 policies from 20 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (Oxlumo)Effective 02/01/2023 - 03/31/2023 | Feb 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Lumasiran (Oxlumo)Effective 03/01/2022 - 01/31/2023 | Mar 1, 2022 | Prior auth requiredInferred from policy title |
| Lumasiran (Oxlumo)Effective 04/01/2023 - 03/31/2024 | Apr 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Oxlumo (lumasiran) Injection | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Oxlumo (lumasiran) InjectionEffective 04/01/2024 - 03/31/2025 | Apr 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Oxlumo (lumasiran) InjectionEffective 04/01/2025 - 03/31/2026 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J0224 |
|---|---|---|
| Oxlumo (Lumasiran) and Rivfloza (Nedosiran) | Jun 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Oxlumo (Lumasiran) and Rivfloza (Nedosiran) – Commercial and Individual Exchange Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Oxlumo (Lumasiran) and Rivfloza (Nedosiran) – Community Plan Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (Oxlumo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Lumasiran (Oxlumo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Oxlumo (lumasiran) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| State and School Employees' Health Insurance Plan - Oxlumo (lumasiran) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (Oxlumo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Lumasiran (Oxlumo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Oxlumo (lumasiran) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Oxlumo (lumasiran) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Oxlumo (Lumasiran) and Rivfloza (Nedosiran) | Jun 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (e.g., Oxlumo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0224 |
|---|---|---|
| OXLUMO (LUMASIRAN) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran Oxlumo | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (Oxlumo) | Mar 2, 2021 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (Oxlumo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (Oxlumo); CP.PHAR.473 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Lumasiran (Oxlumo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Oxlumo (lumasiran) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0224 |
|---|---|---|
| Oxlumo (Lumasiran) and Rivfloza (Nedosiran) | Jun 1, 2026 | Covered |