18 commercial payer policies list J9173. 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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18 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 J9173 |
|---|---|---|
| Durvalumab (Imfinzi) and Tremelimumab-actl (Imjudo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Durvalumab (Imfinzi) and Tremelimumab-actl (Imjudo) | Not recorded | Covered with conditionsInferred from policy title |
| Programmed Death Receptor-1 (PD-1) Antagonists (e.g., Keytruda, Opdivo) and Programmed Death-Ligand 1 (PD-L1) Antagonists (e.g., Tecentriq, Bavencio, Imfinzi) | 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 J9173 |
|---|---|---|
| Durvalumab (Imfinzi) and Tremelimumab-actl (Imjudo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Durvalumab (Imfinzi) and Tremelimumab-actl (Imjudo) | 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 J9173 |
|---|---|---|
| Durvalumab (e.g., Imfinzi) | 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 J9173 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9173 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9173 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9173 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9173 |
|---|---|---|
| IMFINZI (DURVALUMAB) | 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 J9173 |
|---|---|---|
| Durvalumab (Imfinzi) | Jun 1, 2017 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9173 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9173 |
|---|---|---|
| Imfinzi (durvalumab) | 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 J9173 |
|---|---|---|
| Durvalumab (Imfinzi): CP.PHAR.339 | 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 J9173 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9173 |
|---|---|---|
| Durvalumab (Imfinzi) | 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 J9173 |
|---|---|---|
| Imfinzi (durvalumab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |