Policy library / J9307 Commercial payer policies listing J9307 6 policies from 6 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.
Blue Cross Blue Shield of North Dakota policies listing J9307, with the code’s status in each Policy Effective Status of J9307 Pralatrexate PayerPolicy · BCBSND-PRALATREXATE-E7C45EFF84 Not recorded Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
BlueCross BlueShield of Tennessee policies listing J9307, with the code’s status in each Policy Effective Status of J9307 Pralatrexate (Folotyn); Pralatrexate PayerPolicy · BCBSTN-fe268f90ab Jun 12, 2010 Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
Cigna policies listing J9307, with the code’s status in each Policy Effective Status of J9307 Cigna MedOnc Master Drug List.pdf PayerPolicy · EVICORE-HPLAN-CIGNA-18A0ACC73CE9 Not recorded Prior auth required
Health Net Oregon policies listing J9307, with the code’s status in each Policy Effective Status of J9307 Pralatrexate (Folotyn); CP.PHAR.313 PayerPolicy · HEALTHNET_OR-CP-PHAR-313 Not recorded Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
Health Partners Plans / Jefferson Health Plans policies listing J9307, with the code’s status in each Policy Effective Status of J9307 Q4 - 2026 JHP MedOnc Master Drug List.pdf PayerPolicy · EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-39BC225341EE Not recorded Prior auth required
Horizon BCBSNJ policies listing J9307, with the code’s status in each Policy Effective Status of J9307 Pralatrexate (Folotyn) PayerPolicy · BCBSNJ-DRUGS-074-51EBF9E490 Not recorded Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.