43 commercial payer policies list J1301. 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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43 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 J1301 |
|---|---|---|
| Edaravone Injection (Radicava)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. |
| Edaravone Injection (Radicava)Effective 03/01/2022 - 01/31/2023 | Mar 1, 2022 | Prior auth requiredInferred from policy title |
| Edaravone Injection (Radicava)Effective 03/09/2018 - 08/14/2018 | Mar 9, 2018 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Edaravone Injection (Radicava)Effective 04/01/2021 - 02/28/2022 | Apr 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Edaravone Injection (Radicava)Effective 05/01/2020 - 03/31/2021 | May 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Edaravone Injection (Radicava)Effective 08/15/2018 - 05/31/2019 | Aug 15, 2018 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Edaravone Intravenous (Radicava, generic) | Oct 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Radicava (edaravone)Effective 02/01/2024 - 09/30/2024 | 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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| Radicava (edaravone)Effective 10/01/2024 - 09/30/2025 | Oct 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J1301 |
|---|---|---|
| Radicava (edaravone) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Radicava (edaravone) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Radicava ORS (edaravone) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Radicava ORS (edaravone) | 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 J1301 |
|---|---|---|
| Edaravone | May 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Edaravone – 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. |
| Edaravone – 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 J1301 |
|---|---|---|
| Edaravone | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1301 |
|---|---|---|
| Edaravone | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1301 |
|---|---|---|
| Edaravone | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1301 |
|---|---|---|
| Edaravone | Apr 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1301 |
|---|---|---|
| Radicava (edaravone) | 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 - Radicava (edaravone) | 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 J1301 |
|---|---|---|
| Edaravone (Radicava) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Edaravone (Radicava) – 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 J1301 |
|---|---|---|
| Edaravone | May 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1301 |
|---|---|---|
| Edaravone (e.g., Radicava) | 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 J1301 |
|---|---|---|
| Edaravone | Apr 1, 2026 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1301 |
|---|---|---|
| RADICAVA/EDARAVONE | 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 J1301 |
|---|---|---|
| RADICAVA (EDARAVON) | 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 J1301 |
|---|---|---|
| Edaravone Radicava | 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 J1301 |
|---|---|---|
| Edaravone (Radicava) | Jul 28, 2017 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1301 |
|---|---|---|
| Radicava (edaravone injection) | 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 J1301 |
|---|---|---|
| Edaravone (Radicava, Radivaca ORS); CP.PHAR.343 | 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 J1301 |
|---|---|---|
| Edaravone (Radicava) | 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 J1301 |
|---|---|---|
| 00596 edaravone (Radicava, Radicava ORS, generics) | 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 J1301 |
|---|---|---|
| Radicava (edaravone) | 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 J1301 |
|---|---|---|
| Edaravone | May 1, 2026 | Covered |