41 commercial payer policies list J0638. 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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41 policies from 21 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 J0638 |
|---|---|---|
| Canakinumab (Ilaris)Effective 06/01/2023 - 04/30/2024 | Jun 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Canakinumab (Ilaris)Effective 07/01/2021 - 06/30/2022 | Jul 1, 2021 | Prior auth requiredInferred from policy title |
| Canakinumab (Ilaris)Effective 07/01/2022 - 05/31/2023 | Jul 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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| Canakinumab (Ilaris)Effective 08/01/2020 - 06/30/2021 | Aug 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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| Canakinumab (Ilaris)Effective 09/01/2019 - 07/31/2020 | Sep 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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| Canakinumab (Ilaris)Effective 11/02/2018 - 08/31/2019 | Nov 2, 2018 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Ilaris (canakinumab) | 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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| Ilaris (canakinumab)Effective 05/01/2024 - 04/30/2025 | May 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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| Ilaris (canakinumab)Effective 05/01/2025 - 04/30/2026 | May 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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| Policy | Effective | Status of J0638 |
|---|---|---|
| Ilaris (Canakinumab) | Nov 1, 2025 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Ilaris (Canakinumab) – 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. |
| Ilaris (Canakinumab) – 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 J0638 |
|---|---|---|
| Canakinumab (Ilaris) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Canakinumab (Ilaris) | 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 J0638 |
|---|---|---|
| Canakinumab | Apr 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0638 |
|---|---|---|
| Canakinumab | Apr 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0638 |
|---|---|---|
| Canakinumab | Apr 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0638 |
|---|---|---|
| Canakinumab | Apr 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0638 |
|---|---|---|
| Interleukin-1 Inhibitors (Arcalyst, Ilaris, Kineret) | 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 - Interleukin-1 Inhibitors (Ilaris) | 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 J0638 |
|---|---|---|
| Canakinumab (Ilaris) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Canakinumab (Ilaris) | 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 J0638 |
|---|---|---|
| Ilaris (canakinumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Ilaris (canakinumab) | 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 J0638 |
|---|---|---|
| Ilaris (Canakinumab) | Nov 1, 2025 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J0638 |
|---|---|---|
| Canakinumab (e.g., Ilaris) | 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 J0638 |
|---|---|---|
| ILARIS (CANAKINUMAB) | 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 J0638 |
|---|---|---|
| Canakinumab (Ilaris) | Mar 11, 2010 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0638 |
|---|---|---|
| Canakinumab (Ilaris) | 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 J0638 |
|---|---|---|
| Canakinumab (Ilaris); CP.PHAR.246 | 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 J0638 |
|---|---|---|
| Canakinumab (Ilaris) | 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 J0638 |
|---|---|---|
| Canakinumab (Ilaris) | 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 J0638 |
|---|---|---|
| Ilaris (canakinumab) | 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 J0638 |
|---|---|---|
| Ilaris (canakinumab) (PG185, Ver. 3) | 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 J0638 |
|---|---|---|
| Ilaris (Canakinumab) | Nov 1, 2025 | Covered |