25 commercial payer policies list J1628. 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.
Free account. Policy pages stay open to everyone.
25 policies from 17 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 J1628 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Tremfya (Guselkumab) | May 1, 2026 | Covered |
| Tremfya (Guselkumab) – Commercial and Individual Exchange Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title |
| Tremfya (Guselkumab) – 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. |
|---|
| Policy | Effective | Status of J1628 |
|---|---|---|
| Tremfya Intravenous (guselkumab) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Tremfya Intravenous (guselkumab)Effective 02/01/2025 - 07/31/2025 | Feb 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Tremfya Intravenous (guselkumab)Effective 08/01/2025 - 07/31/2026 | Aug 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1628 |
|---|---|---|
| Guselkumab (Tremfya) Injection for Intravenous Use | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Guselkumab (Tremfya) Injection for Intravenous Use | 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 J1628 |
|---|---|---|
| Guselkumab (Tremfya) Injection for Intravenous Use | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Guselkumab (Tremfya) Injection for Intravenous Use | 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 J1628 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Tremfya (Guselkumab) | May 1, 2026 | Covered |
| Policy | Effective | Status of J1628 |
|---|---|---|
| Guselkumab (e.g., Tremfya ) | 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 J1628 |
|---|---|---|
| Guselkumab | May 1, 2026 | Covered |
| Policy | Effective | Status of J1628 |
|---|---|---|
| Guselkumab | May 1, 2026 | Covered |
| Policy | Effective | Status of J1628 |
|---|---|---|
| Guselkumab | May 1, 2026 | Covered |
| Policy | Effective | Status of J1628 |
|---|---|---|
| Guselkumab | May 1, 2026 | Covered |
| Policy | Effective | Status of J1628 |
|---|---|---|
| TREMFYA (GUSELKUMAB) | 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 J1628 |
|---|---|---|
| Guselkumab (Tremfya) | Jan 30, 2025 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1628 |
|---|---|---|
| Tremfya (guselkumab) | 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 J1628 |
|---|---|---|
| 00588 guselkumab (Tremfya) | 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 J1628 |
|---|---|---|
| Tremfya (guselkumab) | 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 J1628 |
|---|---|---|
| Tremfya (guselkumab) Subcutaneous | 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 J1628 |
|---|---|---|
| Tremfya (Guselkumab) | May 1, 2026 | Covered |