26 commercial payer policies list J0257. 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.
Free account. Policy pages stay open to everyone.
26 policies from 13 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 J0257 |
|---|---|---|
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira)Effective 01/01/2019 - 05/31/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira)Effective 04/01/2019 - 04/30/2020 | Apr 1, 2019 | Prior auth requiredInferred from policy title |
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira)Effective 04/01/2022 - 03/31/2023 | Apr 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira)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. |
|---|
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira)Effective 05/01/2020 - 05/31/2021 | May 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira)Effective 06/01/2021 - 03/31/2022 | Jun 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Aralast NP, Glassia, Prolastin-C , and Zemaira (alpha1- proteinase inhibitor [human])Effective 03/01/2025 - 03/31/2025 | Mar 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Aralast NP, Glassia, Prolastin-C , and Zemaira (alpha1- proteinase inhibitor [human])Effective 04/01/2025 - 03/31/2025 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Aralast NP, Glassia, Prolastin-C, and Zemaira (alpha1-proteinase inhibitor [human]) | 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 J0257 |
|---|---|---|
| Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | 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 J0257 |
|---|---|---|
| Alpha-1 antitrypsin (AAT) deficiency enzyme replacement therapy: alpha-1 proteinase inhibitor (Aralast NP, Glassia, Prolastin-C, and Zemaira) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Alpha-1 antitrypsin (AAT) deficiency enzyme replacement therapy: alpha-1 proteinase inhibitor (Aralast NP, Glassia, Prolastin-C, and Zemaira) - Minnesota Health Care Programs | 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 J0257 |
|---|---|---|
| Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | 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 J0257 |
|---|---|---|
| Alpha1-Proteinase Inhibitors | Nov 1, 2025 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J0257 |
|---|---|---|
| Alpha1-Proteinase Inhibitors | Nov 1, 2025 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J0257 |
|---|---|---|
| Alpha1-Proteinase Inhibitors | Apr 25, 2023 | Covered |
| Policy | Effective | Status of J0257 |
|---|---|---|
| Alpha-1 Proteinase Inhibitor Therapy (e.g., Aralast, Glassia, Prolastin, and Zemaira) | 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 J0257 |
|---|---|---|
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira) | Dec 1, 2016 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0257 |
|---|---|---|
| Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira); CP.PHAR.94 | 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 J0257 |
|---|---|---|
| Alpha 1-Proteinase Inhibitors (Human) [Prolastin-C, Aralast NP, Zemaira, Glassia] | 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 J0257 |
|---|---|---|
| Alpha-1-Proteinase Inhibitors: Aralast NP; Glassia; Prolastin-C; Zemaira | 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 J0257 |
|---|---|---|
| Alpha1-Proteinase Inhibitors | Nov 1, 2025 | Covered |