15 commercial payer policies list J1961. 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.
15 policies from 12 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 J1961 |
|---|---|---|
| Sunlenca (lenacapavir) Injection | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Sunlenca (lenacapavir) InjectionEffective 05/01/2024 - 04/30/2025 | May 1, 2024 | Prior auth requiredInferred from policy title |
| Sunlenca (lenacapavir) InjectionEffective 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. |
|---|
| Sunlenca (lenacapavir)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. |
|---|
| Policy | Effective | Status of J1961 |
|---|---|---|
| Lenacapavir (e.g., Sunlenca) | 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 J1961 |
|---|---|---|
| Long-Acting Injectable Antiretroviral Agents for Treatment of HIV | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J1961 |
|---|---|---|
| Long-Acting Injectable Antiretroviral Agents for Treatment of HIV | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J1961 |
|---|---|---|
| Long-Acting Injectable Antiretroviral Agents for Treatment of HIV | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J1961 |
|---|---|---|
| Long-Acting Injectable Antiretroviral Agents for Treatment of HIV | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J1961 |
|---|---|---|
| SUNLENCA (LENACAPAVIR) | 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 J1961 |
|---|---|---|
| Lenacapavir (Sunlenca, Yeztugo); CP.PHAR.622 | 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 J1961 |
|---|---|---|
| 00844 lenacapavir (Sunlenca) | 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 J1961 |
|---|---|---|
| Long-Acting Injectable Antiretroviral Agents for HIV | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1961 |
|---|---|---|
| Long-Acting Injectable Antiretroviral Agents for HIV | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1961 |
|---|---|---|
| Long-Acting Injectable Antiretroviral Agents for HIV | Oct 1, 2026 | Covered |