16 commercial payer policies list J2781. 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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16 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 J2781 |
|---|---|---|
| Syfovre (pegcetacoplan injection) | Jan 1, 2026 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Syfovre (pegcetacoplan injection)Effective 01/01/2025 - 12/31/2025 | Jan 1, 2025 | Prior auth requiredInferred from policy title |
| Syfovre (pegcetacoplan)Effective 01/01/2024 - 12/31/2024 | Jan 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Syfovre (pegcetacoplan)Effective 07/01/2023 - 12/31/2023 | Jul 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 J2781 |
|---|---|---|
| Syfovre (pegcetacoplan injection) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Syfovre (pegcetacoplan injection) | 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 J2781 |
|---|---|---|
| Pegcetacoplan Intravitreal (e.g., Syfovre) | 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 J2781 |
|---|---|---|
| SYFOVRE (PEGCETACOPLAN) | 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 J2781 |
|---|---|---|
| Pegcetacoplan (Syfovre) | Jun 30, 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 J2781 |
|---|---|---|
| Pegcetacoplan (Syfovre) | 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 J2781 |
|---|---|---|
| Pegcetacoplan (Empaveli, Syfovre); CP.PHAR.524 | 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 J2781 |
|---|---|---|
| Syfovre (pegcetacoplan) | 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 J2781 |
|---|---|---|
| Syfovre (pegcetacoplan injection) (PG150, 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 J2781 |
|---|---|---|
| Ophthalmologic Complement Inhibitors | Dec 1, 2025 | Covered |
| Policy | Effective | Status of J2781 |
|---|---|---|
| Ophthalmologic Complement Inhibitors | Dec 1, 2025 | Covered |
| Policy | Effective | Status of J2781 |
|---|---|---|
| Ophthalmologic Complement Inhibitors | Dec 1, 2025 | Covered |