Erythropoiesis Stimulating Agents
J6
13 active Medicare policies list Q5106, and 27 commercial payer policies list it. 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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J6
J6 · Effective Jul 15, 2026
JK
JK · Effective Jul 15, 2026
JJ · Effective Jul 24, 2022
JM · Effective Jul 24, 2022
J15 · Effective Oct 1, 2015
J15
J5 · Effective Oct 1, 2015
J8 · Effective Oct 1, 2015
27 policies from 14 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 Q5106 |
|---|---|---|
| Epoetin alfa (Epogen, Procrit, Retacrit)Effective 10/01/2022 - 09/30/2023 | Oct 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Epoetin alfa (Epogen, Procrit, Retacrit)Effective 11/01/2021 - 09/30/2022 | Nov 1, 2021 | Prior auth requiredInferred from policy title |
National · Effective Apr 1, 2025
National · Effective Mar 5, 2026
J5 · Effective Apr 1, 2025
| Epogen, Procrit, or Retacrit (epoetin alfa) Non-oncologyEffective 10/01/2023 - 09/30/2024 | Oct 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Epogen, Procrit, Retacrit (epoetin alfa) Injection Non-oncology | Oct 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Epogen, Procrit, Retacrit (epoetin alfa) Injection Non-oncologyEffective 10/01/2024 - 09/30/2025 | Oct 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Epogen, Procrit, Retacrit (epoetin alfa) Injection Non-oncologyEffective 10/01/2026 | 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 Q5106 |
|---|---|---|
| Erythropoiesis-Stimulating Agents (ESAs) | Jan 1, 2026 | Covered |
| Oncology Medications | Jul 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Erythropoiesis-Stimulating Agents (ESAs) | Jan 1, 2026 | Covered |
| Oncology Medications | Jul 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Erythropoiesis-Stimulating Agents (ESAs) | Jan 1, 2026 | Covered |
| Oncology Medications | Jul 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Erythropoiesis-Stimulating Agents (ESAs) | Jan 1, 2026 | Covered |
| Oncology Medications | Jul 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Epoetin Alfa Products(Epogen, Procrit, Retacrit) | Jan 14, 2006 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Epoetin Alfa (Epogen, Procrit), Epoetin alfa-epbx (Retacrit); CP.PHAR.237 | 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 Q5106 |
|---|---|---|
| Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| 00210 Erythropoiesis-Stimulating Agents (ESA’s): epoetin alfa (Epogen and Procrit), epoetin alfa-epbx (Retacrit), darbepoetin alfa (Aranesp), and pegylated epoetin beta (Mircera) | 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 Q5106 |
|---|---|---|
| Epoetin alfa: Epogen; Procrit; Retacrit | 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 Q5106 |
|---|---|---|
| Erythropoiesis-Stimulating Agents | Apr 1, 2026 | Covered |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Erythropoiesis-Stimulating Agents | Apr 1, 2026 | Covered |
| Policy | Effective | Status of Q5106 |
|---|---|---|
| Erythropoiesis-Stimulating Agents | Apr 1, 2026 | Covered |