Chemotherapy Drugs and their Adjuncts
J5 · Effective Sep 16, 2017
11 active Medicare policies list Q5115, and 36 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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J5 · Effective Sep 16, 2017
J8 · Effective Sep 16, 2017
J15 · Effective Aug 8, 2021
J6 · Effective Nov 1, 2022
JK · Effective Nov 1, 2022
JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
J5 · Effective Nov 27, 2025
National · Effective Sep 3, 2026
J6 · Effective Apr 1, 2026
36 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 Q5115 |
|---|---|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Rituximab (Rituxan, Ruxience, Truxima, Riabni)_Non-oncologyEffective 06/01/2024 - 02/28/2025 | Jun 1, 2024 | Prior auth requiredInferred from policy title |
National · Effective Oct 1, 2025
| Rituximab (Rituxan, Ruxience, Truxima, Riabni)Effective 05/01/2025 - 04/30/2026 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni)Effective 07/01/2021 - 06/30/2022 | Jul 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni)Effective 07/01/2022 - 06/30/2023 | Jul 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Rituximab (Rituxan, Ruxience, Truxima, Riabni)Effective 07/01/2023 - 05/31/2024 | Jul 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Rituximab (Rituxan, Ruxience, Truxima)Effective 09/01/2020 - 06/30/2021 | Sep 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) | Jan 1, 2026 | Covered |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) – 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. |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) – 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 Q5115 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Rituximab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Rituximab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Rituximab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Rituximab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Rituximab Products (Rituxan, Rituximab-abbs [Truxima],Rituximab-arrx [Riabni] and Rituximab-pvvr [Ruxience]) (Non-Oncology Indications) | Feb 26, 2003 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Rituximab Products (Rituxan, Rituximab-abbs [Truxima],Rituximab-arrx [Riabni] and Rituximab-pvvr [Ruxience]) (Oncology Indications) | Feb 26, 2003 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Oncology** - rituximab (Rituxan, Ruxience, Truxima, Rituxan Hycela, and Riabni) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Oncology** - rituximab (Rituxan, Ruxience, Truxima, Rituxan Hycela, and Riabni) – Minnesota Health Care Programs | 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 Q5115 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Rituximab Rituxan Truxima AND Rituximab AND Hyaluronidase Human Rituxan Hycela | 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 Q5115 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5115 |
|---|---|---|
| Rituximab (Rituxan), Rituximab-abbs (Truxima), Rituximab-pvvr (Ruxience), and Rituximab/hyaluronidase (Rituxan Hycela) | 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 Q5115 |
|---|---|---|
| Rituximab: Rituxan, Truxima, Ruxience, Riabni | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |