35 commercial payer policies list J1303. 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 20 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 J1303 |
|---|---|---|
| Ravulizumab-cwvz (Ultomiris)Effective 01/01/2022 - 01/31/2023 | Jan 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Ravulizumab-cwvz (Ultomiris)Effective 02/01/2023 - 01/31/2024 | Feb 1, 2023 | Prior auth requiredInferred from policy title |
| Ravulizumab-cwvz (Ultomiris)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. |
|---|
| Ravulizumab-cwvz (Ultomiris)Effective 03/15/2021 - 12/31/2021 | Mar 15, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Ravulizumab-cwvz (Ultomiris)Effective 05/01/2019 - 02/29/2020 | May 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Ultomiris (ravulizumab-cwvz) Intravenous Injection | Jan 1, 2026 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Ultomiris (ravulizumab-cwvz) Intravenous InjectionEffective 01/01/2025 - 01/01/2026 | Jan 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Ultomiris (ravulizumab-cwvz)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. |
|---|
| Policy | Effective | Status of J1303 |
|---|---|---|
| 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 J1303 |
|---|---|---|
| Ravulizumab-cwvz | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1303 |
|---|---|---|
| Ravulizumab-cwvz | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1303 |
|---|---|---|
| Ravulizumab-cwvz | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1303 |
|---|---|---|
| Ravulizumab-cwvz | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1303 |
|---|---|---|
| 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 J1303 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1303 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1303 |
|---|---|---|
| Ravulizumab-cwvz (e.g., 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 J1303 |
|---|---|---|
| ULTOMIRIS, PIASKY, UPLIZNA, EMPAVELI, PIASKY,RYSTIGGO, IMAAVY | 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 J1303 |
|---|---|---|
| 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 J1303 |
|---|---|---|
| ULTOMIRIS (RAVULIZUMAB-CWVZ) | 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 J1303 |
|---|---|---|
| Ravulizumab-cwvz (Ultomiris) | May 31, 2019 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1303 |
|---|---|---|
| Ravulizumab-cwvz (Ultomiris); CP.PHAR.415 | 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 J1303 |
|---|---|---|
| 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 J1303 |
|---|---|---|
| 00671 ravulizumab (Ultomiris), eculizumab Products | 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 J1303 |
|---|---|---|
| Ultomiris (ravulizumab-cwvz) | 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 J1303 |
|---|---|---|
| Ultomiris (ravulizumab-cwvz) (PG189, 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 J1303 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |