11 commercial payer policies list J1454. 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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11 policies from 11 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 J1454 |
|---|---|---|
| Antiemetic Therapy | Feb 27, 2024 | Covered |
| Policy | Effective | Status of J1454 |
|---|---|---|
| Akynzeo (netupitant and palonosetron) | Not recorded | Covered with conditionsInferred from policy title |
| Policy | Effective | Status of J1454 |
|---|---|---|
| FOSNETUPITANT PALONOSETRON INJECTION: AKYNZEO (C9033) RETIRED AS OF 10/8/2020 | 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 J1454 |
|---|---|---|
| Netupitant and Palonosetron (Akynzeo), Fosnetupitant and Palonosetron (Akynzeo IV); CP.PMN.158 | 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 J1454 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J1454 |
|---|---|---|
| Injectable Antiemetic Agents [Dolasetron (Anzemet), Granisetron (Kytril, Sustol), Ondansetron (Zofran), Palonosetron (Aloxi), Rolapitant (Varubi), Aprepitant (Cinvanti), Fosaprepitant (Emend), and Fosnetupitant/Palonosetron (Akynzeo), Amisulpride (Barhemsys)] | 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 J1454 |
|---|---|---|
| Akynzeo (fosnetupitant/palonosetron) | 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 J1454 |
|---|---|---|
| Akynzeo (netupitant/palonosetron) | 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 J1454 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J1454 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J1454 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |