J0577 Inj, brixadi, 7 days or lessInjection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy
J0577 payment limit: $433.167 per Less than or equal to 7 days of therapy, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
58284-0208-01 Brixadi (weekly dosing), Braeburn Inc.: 1 billing unit per package (1 SYRINGE, GLASS in 1 CARTON / .16 mL in 1 SYRINGE, GLASS)58284-0216-01 Brixadi (weekly dosing), Braeburn Inc.: 1 billing unit per package (1 SYRINGE, GLASS in 1 CARTON / .32 mL in 1 SYRINGE, GLASS)58284-0224-01 Brixadi (weekly dosing), Braeburn Inc.: 1 billing unit per package (1 SYRINGE, GLASS in 1 CARTON / .48 mL in 1 SYRINGE, GLASS)58284-0232-01 Brixadi (weekly dosing), Braeburn Inc.: 1 billing unit per package (1 SYRINGE, GLASS in 1 CARTON / .64 mL in 1 SYRINGE, GLASS)Status E: excluded from the PFS by regulation.
2 of 2 payer prior-auth lists that name J0577 require prior authorization or set conditions: Humana, Molina Healthcare of Mississippi.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Humana Healthy Horizons | IN | prior auth required | Oct 14, 2026 | Humana Healthy Horizons in Indiana prior authorization and notification list for provider-administered medications | |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth required | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 |
J0577 appears in 5 coverage policies from Aetna, Centene, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Extended-Release Buprenorphine Injectables (0910) | covered if criteria are met | Dec 30, 2025 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J0278-J2543) | Mar 5, 2026 | payer document |
| Centene | Buprenorphine Injection (Sublocade, Brixadi) (CP.PHAR.289) | covered if criteria are met | Feb 1, 2026 | payer document |
| UnitedHealthcare | Buprenorphine (Brixadi® & Sublocade®) (2025D0057S) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Buprenorphine (Brixadi® & Sublocade®) (CS2026D0057Y) | listed, no stance | Apr 1, 2026 | payer document |
Prior authorization required or conditional in IN.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.