29 commercial payer policies list J1786. 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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29 policies from 15 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 J1786 |
|---|---|---|
| Cerezyme (imiglucerase) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Cerezyme (imiglucerase)Effective 05/01/2024 - 04/30/2025 | May 1, 2024 | Prior auth requiredInferred from policy title |
| Cerezyme (imiglucerase)Effective 05/01/2025 - 04/30/2026 | May 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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| Imiglucerase (Cerezyme)Effective 01/01/2019 - 08/31/2019 | Jan 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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| Imiglucerase (Cerezyme)Effective 06/01/2022 - 05/31/2023 | Jun 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Imiglucerase (Cerezyme)Effective 06/01/2023 - 04/30/2024 | Jun 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Imiglucerase (Cerezyme)Effective 07/01/2021 - 05/31/2022 | Jul 1, 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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| Imiglucerase (Cerezyme)Effective 08/01/2020 - 06/30/2021 | Aug 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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| Imiglucerase (Cerezyme)Effective 09/01/2019 - 07/31/2020 | Sep 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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| Policy | Effective | Status of J1786 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1786 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1786 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1786 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1786 |
|---|---|---|
| Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease | Jun 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J1786 |
|---|---|---|
| Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease | Jun 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J1786 |
|---|---|---|
| Treatment for Gaucher Disease: [Imiglucerase (e.g., Cerezyme), taliglucerase alfa (e.g., Elelyso), and velaglucerase alfa (e.g., Vpriv)] | 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 J1786 |
|---|---|---|
| CEREZYME (IMIGLUCERASE) ENZYME REPLACEMENT THERAPY (J1786) 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 J1786 |
|---|---|---|
| Imiglucerase (Cerezyme) | Dec 7, 2023 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1786 |
|---|---|---|
| Imiglucerase (Cerezyme); CP.PHAR.154 | 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 J1786 |
|---|---|---|
| Gaucher disease enzyme replacement therapy: imiglucerase (Cerezyme), velaglucerase (Vpriv), and taliglucerase (Elelyso) | 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 J1786 |
|---|---|---|
| Cerezyme (imiglucerase) | 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 J1786 |
|---|---|---|
| Cerezyme (imiglucerase), Elelyso (taliglucerase alfa), VPRIV velaglucerase alfa) | 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 J1786 |
|---|---|---|
| Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease | Jun 1, 2026 | Covered |