J1202 Miglustat oral 65 mgMiglustat, oral, 65 mg
Status I: not valid for Medicare (Medicare uses another code).
18 of 18 payer prior-auth lists that name J1202 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California Promise Health Plan, Cigna, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of New Mexico, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky), UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth required | Request from member's PBM | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | Request from member's PBM | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Teamsters group (TYW) | AZ | prior auth required | Request from member's PBM | Sep 1, 2026 | Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Blue Shield of California Promise Health Plan | Promise Health Plan Medi-Cal | CA | prior auth required | Sep 1, 2026 | Medi-Cal Prior Authorization List | |
| Cigna | ACA/IFP | All | prior auth required | Apr 1, 2024 | Master Precertification List (For Health Care Providers) | |
| Cigna | Basic Standard | All | prior auth required | Apr 1, 2024 | Master Precertification List (For Health Care Providers) | |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | Apr 1, 2024 | Master Precertification List (For Health Care Providers) | |
| Humana | Humana Healthy Horizons | OK | prior auth required | Oct 14, 2026 | Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List | |
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth required | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Apr 1, 2024 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth required | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 | |
| Molina Healthcare of New Mexico | Medicaid | NM | prior auth required | Molina follows New Mexico Senate Bill 39 and waives PA where applicable | Jul 1, 2026 | New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 |
| Molina Healthcare of Utah | Medicaid | UT | prior auth required | Jan 1, 2025 | Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 | |
| UnitedHealthcare Community Plan | KanCare | KS | prior auth required | Oct 1, 2026 | Prior authorization requirements for Kansas Medicaid Effective October 1, 2026 |
J1202 appears in 8 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Centene, Cigna, Premera Blue Cross, Wellmark Blue Cross Blue Shield.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Injectable Medications (0020) | listed, no stance (range J0278-J2543) | Mar 5, 2026 | payer document |
| Aetna | Lysosomal Storage Disorder Treatments (0442) | listed, no stance | Jul 8, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Lysosomal Storage Disorders (L.5.01.526) | listed, no stance | payer document | |
| Centene | Cipaglucosidase Alfa-atga + Miglustat (Pombiliti + Opfolda) Reference Number: CP.PHAR.567 (CP.PHAR.567) | covered if criteria are met | Feb 1, 2026 | payer document |
| Centene | Miglustat (Zavesca) (CP.PHAR.164) | covered if criteria are met | May 1, 2026 | payer document |
| Cigna | Pompe Disease – Enzyme Stabilization Therapy – Opfolda (IP0598) | covered if criteria are met | Jul 15, 2026 | payer document |
| Premera Blue Cross | Drugs for Rare Diseases (5.01.576) Page | 68 of 128 | ∞ | listed, no stance | Aug 11, 2026 | payer document |
| Wellmark Blue Cross Blue Shield | Enzyme Replacement Therapy (05.02.91) | listed, no stance | Jun 1, 2026 | payer document |
Prior authorization required or conditional in IN, MS, VT.
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.