Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list J1299, and 35 commercial payer policies list it. 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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J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
J6 · Effective Apr 1, 2026
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 J1299 |
|---|---|---|
| Eculizumab (Soliris)Effective 01/01/2019 - 06/30/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Eculizumab (Soliris)Effective 02/01/2022 - 01/31/2023 | Feb 1, 2022 | Prior auth requiredInferred from policy title |
| Eculizumab (Soliris)Effective 02/01/2023 - 01/31/2024 | Feb 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Eculizumab (Soliris)Effective 03/01/2020 - 03/14/2021 | Mar 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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| Eculizumab (Soliris)Effective 03/15/2021 - 01/31/2021 | Mar 15, 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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| Eculizumab (Soliris)Effective 07/01/2019 - 02/29/2020 | 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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| Eculizumab Products (Soliris, Bkemv, Epysqli) | 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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| Eculizumab Products (Soliris, Bkemv, Epysqli)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. |
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| Soliris (eculizumab)Effective 01/01/2025 - 06/30/2025 | Jan 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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| Soliris (eculizumab)Effective 02/01/2024 - 12/31/2024 | 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 J1299 |
|---|---|---|
| Eculizumab (Soliris) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris) for intravenous administration | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Eculizumab (Soliris) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris) for intravenous administration | 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 J1299 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1299 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1299 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1299 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1299 |
|---|---|---|
| Eculizumab (Soliris) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris) for intravenous administration | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Eculizumab (Soliris) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris) for intravenous administration | 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 J1299 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1299 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1299 |
|---|---|---|
| Eculizumab (e.g., Soliris) and Biosimilars | 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 J1299 |
|---|---|---|
| ECULIZUMAB/SOLIRIS | 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 J1299 |
|---|---|---|
| Soliris, Ultomiris, Complement 3 Glomerulopathy (C3G), Myasthenia Gravis, Paroxysmal nocturnal hemoglobinuria (PNH), and Neuromyelitis Optica 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 J1299 |
|---|---|---|
| Eculizumab Soliris | 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 J1299 |
|---|---|---|
| Eculizumab (Soliris), Eculizumab-aeeb (Bkemv), Eculizumab-aagh (Epysqli); CP.PHAR.97 | 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 J1299 |
|---|---|---|
| Eculizumab (Soliris) and Ravulizumab-cwvz (Ultomiris) | 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 J1299 |
|---|---|---|
| Eculizumab: Soliris; Bkemv; Epysqli | 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 J1299 |
|---|---|---|
| Soliris (eculizumab) and Biosimilars (PG188, Ver. 4) | 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 J1299 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |