45 commercial payer policies list J0490. 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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45 policies from 22 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 J0490 |
|---|---|---|
| Belimumab (Benlysta)Effective 01/01/2019 - 07/01/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Belimumab (Benlysta)Effective 01/01/2023 - 01/31/2024 | Jan 1, 2023 | Prior auth requiredInferred from policy title |
| Belimumab (Benlysta)Effective 04/01/2022 - 12/31/2022 | Apr 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Belimumab (Benlysta)Effective 05/01/2021 - 03/31/2022 | May 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Belimumab (Benlysta)Effective 06/01/2020 - 04/30/2021 | Jun 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Belimumab (Benlysta)Effective 07/01/2019 - 05/31/2020 | Jul 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Benlysta (belimumab) Intravenous Injection | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Benlysta (belimumab) Intravenous InjectionEffective 07/01/2024 - 06/30/2025 | Jul 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Benlysta (belimumab) Intravenous InjectionEffective 07/01/2025 - 06/30/2026 | Jul 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Benlysta (belimumab)Effective 02/01/2024 - 06/30/2024 | Feb 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Policy | Effective | Status of J0490 |
|---|---|---|
| Benlysta (belimumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Benlysta (belimumab) Intravenous | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Benlysta (belimumab) Intravenous | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Benlysta (belimumab) Subcutaneous | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Benlysta (belimumab) Subcutaneous | 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 J0490 |
|---|---|---|
| Benlysta (Belimumab) | Dec 1, 2025 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Benlysta (Belimumab) – 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. |
| Benlysta (Belimumab) – 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. |
| Policy | Effective | Status of J0490 |
|---|---|---|
| Belimumab (Benlysta) for Intravenous Use | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Belimumab (Benlysta) for Intravenous Use | 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 J0490 |
|---|---|---|
| Belimumab | May 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0490 |
|---|---|---|
| Belimumab | May 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0490 |
|---|---|---|
| Belimumab | May 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0490 |
|---|---|---|
| Belimumab | May 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0490 |
|---|---|---|
| Belimumab (Benlysta) for Intravenous Use | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Belimumab (Benlysta) for Intravenous Use | 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 J0490 |
|---|---|---|
| Benlysta (Belimumab) | Dec 1, 2025 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J0490 |
|---|---|---|
| Belimumab (e.g., Benlysta) | 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 J0490 |
|---|---|---|
| BENLYSTA (BELIMUMAB) | 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 J0490 |
|---|---|---|
| Belimumab Benlysta | 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 J0490 |
|---|---|---|
| Belimumab (Benlysta) | Aug 13, 2011 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0490 |
|---|---|---|
| Benlysta (belimumab) | 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 J0490 |
|---|---|---|
| Belimumab (Benlysta); CP.PHAR.88 | 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 J0490 |
|---|---|---|
| Anifrolumab (Saphnelo) and belimumab (Benlysta) | 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 J0490 |
|---|---|---|
| Belimumab (Benlysta) | 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 J0490 |
|---|---|---|
| 00295 belimumab (Benlysta) | 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 J0490 |
|---|---|---|
| Benlysta (belimumab) | 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 J0490 |
|---|---|---|
| Benlysta (belimumab) (PG014, Ver. 9) | 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 J0490 |
|---|---|---|
| Benlysta (Belimumab) | Dec 1, 2025 | Covered |