20 commercial payer policies list J9301. 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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20 policies from 18 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 J9301 |
|---|---|---|
| Gazyva (Obinutuzumab) | Jan 1, 2026 | Covered |
| Gazyva (Obinutuzumab) – Community Plan Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Gazyva (Obinutuzumab) – Individual Exchange Medical Benefit Drug Policy | 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 J9301 |
|---|---|---|
| Obinutuzumab (e.g., Gazyva) | 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 J9301 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9301 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9301 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9301 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9301 |
|---|---|---|
| GAZYVA (OBINUTUZUMAB) | 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 J9301 |
|---|---|---|
| Obinutuzumab Gazyva | 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 J9301 |
|---|---|---|
| Gazyva (obinutuzumab) for Non-oncologic Uses. Medical Policy MP 5.01.673 Gazyva (obinutuzumab) for Non-oncologic Uses DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general | 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 J9301 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9301 |
|---|---|---|
| Gazyva (obinutuzumab) Injection Non-oncology | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9301 |
|---|---|---|
| Obinutuzumab (Gazyva); CP.PHAR.305 | 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 J9301 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9301 |
|---|---|---|
| Oncology - obinutuzumab (Gazyva) | 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 J9301 |
|---|---|---|
| Gazyva (Obinutuzumab) | 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 J9301 |
|---|---|---|
| Gazyva (obinutuzumab) | 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 J9301 |
|---|---|---|
| Gazyva (Obinutuzumab) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J9301 |
|---|---|---|
| Gazyva (Obinutuzumab) | Jan 1, 2026 | Covered |