11 commercial payer policies list J9201. 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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11 policies from 11 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 J9201 |
|---|---|---|
| Gemcitabine branded intravenous infusion (e.g., Avgemsi) | 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 J9201 |
|---|
| INLEXZO (GEMCITABINE) | 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 J9201 |
|---|---|---|
| Gemcitabine (Inlexzo) intravesical system | Jan 30, 2026 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9201 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9201 |
|---|---|---|
| Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List | Not recorded | Prior auth required |
| Policy | Effective | Status of J9201 |
|---|---|---|
| Oncology - gemcitabine intravesical system (Inlexzo) | 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 J9201 |
|---|---|---|
| Gemcitabine in sodium chloride injection (Infugem) | 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 J9201 |
|---|---|---|
| Inlexzo (gemcitabine) | 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 J9201 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J9201 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J9201 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |