35 commercial payer policies list J0491. 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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35 policies from 18 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 J0491 |
|---|---|---|
| Anifrolumab-fnia (Saphnelo)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. |
| Anifrolumab-fnia (Saphnelo)Effective 04/01/2023 - 02/29/2024 | Apr 1, 2023 | Prior auth requiredInferred from policy title |
| Anifrolumab-fnia (Saphnelo)Effective 12/01/2021 - 03/31/2022 | Dec 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Saphnelo (anifrolumab-fnia) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Saphnelo (anifrolumab-fnia)Effective 03/01/2024 - 06/30/2024 | Mar 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Saphnelo (anifrolumab-fnia)Effective 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. |
|---|
| Saphnelo (anifrolumab-fnia)Effective 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. |
|---|
| Policy | Effective | Status of J0491 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Saphnelo (Anifrolumab-Fnia) | Jul 1, 2026 | Covered |
| Saphnelo (Anifrolumab-Fnia) – 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. |
| Saphnelo (Anifrolumab-Fnia) – 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 J0491 |
|---|---|---|
| Anifrolumab-fnia (Saphnelo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Anifrolumab-fnia (Saphnelo) | 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 J0491 |
|---|---|---|
| Anifrolumab-fnia | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0491 |
|---|---|---|
| Anifrolumab-fnia | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0491 |
|---|---|---|
| Anifrolumab-fnia | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0491 |
|---|---|---|
| Anifrolumab-fnia | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0491 |
|---|---|---|
| Anifrolumab-fnia (Saphnelo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Anifrolumab-fnia (Saphnelo) | 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 J0491 |
|---|---|---|
| Saphnelo (anifrolumab-fnia) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Saphnelo (anifrolumab-fnia) | 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 J0491 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Saphnelo (Anifrolumab-Fnia) | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J0491 |
|---|---|---|
| Anifrolumab-fnia (e.g., Saphnelo) | 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 J0491 |
|---|---|---|
| SAPHNELO (ANIFROLUMAB-FNIA) | 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 J0491 |
|---|---|---|
| Anifrolumab-fnia (Saphnelo) | Nov 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 J0491 |
|---|---|---|
| Anifrolimab-fnia (Saphnelo); CP.PHAR.551 | 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 J0491 |
|---|---|---|
| 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 J0491 |
|---|---|---|
| 00767 anifrolumab (Saphnelo) | 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 J0491 |
|---|---|---|
| Saphnelo (anifrolumab-fnia) | 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 J0491 |
|---|---|---|
| Saphnelo (Anifrolumab-Fnia) | Jul 1, 2026 | Covered |