J1943 Inj., aristada initio, 1 mgInjection, aripiprazole lauroxil, (aristada initio), 1 mg
J1943 payment limit: $3.459 per 1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
65757-0500-03 Aristada Initio, Alkermes, Inc.: 675 billing units per package (1 SYRINGE in 1 CARTON / 2.4 mL in 1 SYRINGE)Status E: excluded from the PFS by regulation.
1 of 3 payer prior-auth lists that name J1943 require prior authorization or set conditions: UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare Community Plan | KanCare | KS | prior auth required | Oct 1, 2026 | Prior authorization requirements for Kansas Medicaid Effective October 1, 2026 |
J1943 appears in 4 coverage policies from Aetna, Centene.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Electroconvulsive Therapy (0445) | listed, no stance | Jul 29, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J0278-J2543) | Mar 5, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) Tetrabenazine | covered if criteria are met | Jul 24, 2026 | payer document |
| Centene | Aripiprazole Long-Acting Injections (Abilify Maintena, Abilify Asimtufii, Aristada, Aristada Initio) (CP.PHAR.290) | covered if criteria are met | Aug 1, 2026 | payer document |
Prior authorization required or conditional in NE, WA.
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.