`J3590` Unclassified biologics

Unclassified biologics

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medicare pricing for J3590

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J3590

626 of 626 payer prior-auth lists that name J3590 require prior authorization or set conditions: Aetna, Arkansas Blue Cross and Blue Shield, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Texas, Blue Shield of California Promise Health Plan, CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Arkansas Blue Cross and Blue Shield	Drugs under the medical benefit (not ASE/PSE or FEP, which use EBRx and Prime)	AR	prior auth under conditions	Unlisted drug code: PA for Kebilidi	Mar 12, 2025	Medical Benefit Pharmacy Prior Approval List
Arkansas Blue Cross and Blue Shield	Drugs under the medical benefit (not ASE/PSE or FEP, which use EBRx and Prime)	AR	prior auth under conditions	Unlisted drug code: PA for Rethymic	Aug 22, 2022	Medical Benefit Pharmacy Prior Approval List
Arkansas Blue Cross and Blue Shield	Drugs under the medical benefit (not ASE/PSE or FEP, which use EBRx and Prime)	AR	prior auth under conditions	Unlisted drug code: PA for Revcovi	Apr 1, 2025	Medical Benefit Pharmacy Prior Approval List
Blue Cross Blue Shield of Arizona (AZ Blue)	AZ Blue-administered Medicare Advantage (M2K)	AZ	prior auth under conditions	Unclassified code: PA only for the listed drugs	Sep 1, 2026	AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Federal Employee Program (FEP)	AZ	prior auth under conditions	Unclassified code: PA only for the listed drugs	Sep 1, 2026	Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth under conditions	Unclassified code: PA only for the listed drugs	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 under conditions	Unclassified code: PA only for the listed drugs	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 under conditions	Unclassified code: PA only for the listed drugs	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 under conditions	Unlisted drug code: PA for the listed drug(s)	Sep 1, 2026	Medi-Cal Prior Authorization List
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Amtagvi	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Cetrotide	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Cortrophin Gel	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Dawnzera	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Decnupaz (pivekimab sunirine-pvzy)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Denosumab-bnht (unbranded); Step therapy applies	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Denosumab-dssb (unbranded)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Ennumo (pegfilgrastim-pccg)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Enspryng	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Evdi (trabectedin)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Filkri	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Follistim AQ	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Ganirelix AC	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Gonal-f	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Gonal-f RFF	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Immgolis Intri (golimumab-sldi)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Kebilidi	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Kresladi	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Lantidra	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Leqembi SQ	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Letybo	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Loargys	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Lytenava	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Menopur	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Omisirge	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Otarmeni	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Penpulimab-kcqx	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Poherdy	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Ponlimsi	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Ranluspec (ranibizumab-hkdz)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Revtorpyk	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Rivfloza	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Saphnelo SC	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Sarclisa Escena SC	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Skytrofa	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Strensiq	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Tregzi	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Wainua	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Winrevair	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Xbryk; Step therapy applies	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for ustekinumab (unbranded); Step therapy applies	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for ustekinumab-aauz (unbranded); Step therapy applies	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for ustekinumab-aekn (unbranded); Step therapy applies	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for ustekinumab-stba; Step therapy applies	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for ustekinumab-ttwe (unbranded)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Commercial	All	prior auth under conditions	When billed for Letybo	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Cortrophin Gel	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Genglycos	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Kresladi	Jul 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Lantidra	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Myalept	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Otarmeni	Jul 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Pasatru	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Revtorpyk	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Jul 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Sarclisa Escena SC	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Tregzi	Aug 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Tudriqev	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Vyjuvek	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Zanvastro	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Strensiq	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Ennumo	Aug 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Apr 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Dawnzera	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Aug 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®

Payer coverage policies that name J3590

J3590 appears in 286 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare, Wellmark Blue Cross Blue Shield.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J3570-J3590)	Mar 5, 2026	payer document
Anthem	Defined Composition Cellular Immunotherapy for Select Leukemias or Myelodysplastic Syndrome (MED.00164)	covered if criteria are met	Aug 13, 2026	payer document
Anthem	Gene Therapy for Aromatic L-Amino Acid Decarboxylase Deficiency (MED.00151)	unproven / investigational	Feb 19, 2026	payer document
Anthem	Gene Therapy for Glycogen Storage Disease Type Ia (GSD-Ia) (MED.00167)	unproven / investigational	Sep 4, 2026	payer document
Anthem	Gene Therapy for Hemophilia (MED.00135)	unproven / investigational	May 14, 2026	payer document
Anthem	Gene Therapy for Ocular Conditions (MED.00120)	unproven / investigational	Feb 19, 2026	payer document
Anthem	Gene Therapy for Severe Leukocyte Adhesion Deficiency-I (MED.00149)	covered if criteria are met	Aug 13, 2026	payer document
Anthem	Gene Therapy for Treatment of Hearing Loss (MED.00165)	covered if criteria are met	Aug 13, 2026	payer document
Anthem	Gene Therapy for Wiskott-Aldrich Syndrome (MED.00161)	covered if criteria are met	May 14, 2026	payer document
Anthem	Thymus Tissue Transplantation (TRANS.00038)	covered if criteria are met	Feb 19, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Agents For Recurrent Clostridioides Difficile (L.5.01.604)	not covered		payer document
Blue Cross & Blue Shield of Mississippi	Antirheumatic Biologicals (S.5.01.404)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Antirheumatic Biologicals (L.5.01.404)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Biosimilar Medications (S.5.01.593)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Cellular Immunotherapy For Prostate Cancer	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Dupixent Dupilumab (L.5.01.513)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Gene Therapy For The Treatment Of Metachromatic Leukodystrophy (S.5.01.611)	not covered		payer document
Blue Cross & Blue Shield of Mississippi	Gene Therapy For The Treatment Of Metachromatic Leukodystrophy (L.5.01.611)	not covered		payer document
Blue Cross & Blue Shield of Mississippi	Injectable Oncology (S.5.01.561)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Injectable Oncology (L.5.01.561)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Kebilidi Eladocagene Exuparvovectneq (L.5.01.622)	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Kebilidi Eladocagene Exuparvovectneq (S.5.01.622)	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Multiple Sclerosis (L.5.01.452)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Multiple Sclerosis (S.5.01.452)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Palynziq Pegvaliasepqpz (S.5.01.536)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Palynziq Pegvaliasepqpz (L.5.01.536)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Papzimeos Zopapogene Imadenovec Drba (L.5.01.632)	not covered		payer document
Blue Cross & Blue Shield of Mississippi	Revcovi Elapegademaselvlr (S.5.01.619)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Revcovi Elapegademaselvlr (L.5.01.619)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	State And School Employees Health Insurance Plan Papzimeos Zopapogene (S.5.01.632)	not covered		payer document
Blue Cross & Blue Shield of Mississippi	Tepezza Teprotumumabtrbw (L.5.01.571)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Tepezza Teprotumumabtrbw (S.5.01.571)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Treatment Of Epidermolysis Bullosa (S.5.01.605)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Treatment Of Epidermolysis Bullosa (L.5.01.605)	listed, no stance		payer document
Blue Cross & Blue Shield of Rhode Island	Autologous Serum Eye Drops Medicare Advantage Plans and Commercial Products	listed, no stance	Oct 1, 2025	payer document
Blue Cross Blue Shield of Massachusetts	Antisense Oligonucleotide Medications (027)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	CAR T-Cell Therapy Services for the Treatment of Diffuse Large B-cell Lymphoma (axicabtagene cilleucel or tisagenlecleucel) Prior Authorization Request Form #924	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Gene Therapies for Sickle Cell Disease (050)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	Med UM Policy (033)	covered if criteria are met		payer document
BlueCross BlueShield of South Carolina	Allogeneic processed thymus tissue–agdc (Rethymic®) (CAM 914) Unclassified drugs	listed, no stance	Feb 1, 2026	payer document
BlueCross BlueShield of South Carolina	Amtagvi (lifileucel) (CAM 924)	listed, no stance	Apr 1, 2026	payer document
BlueCross BlueShield of South Carolina	Crizanlizumab-tmca (Adakveo) (CAM 240)	listed, no stance	Feb 1, 2026	payer document
BlueCross BlueShield of South Carolina	Dupixent (CAM 945)	listed, no stance	Nov 1, 2025	payer document
BlueCross BlueShield of South Carolina	ENCELTO (revakinagene taroretcel-lwey) (CAM 954)	listed, no stance	Mar 1, 2026	payer document
BlueCross BlueShield of South Carolina	Elevidys® (delandistrogene moxeparvovec-rokl) (CAM 912) Injection, delandistrogene moxeparvovec-roki, per therapeutic dose; 1 billable unit=1 therapeutic dose	listed, no stance	Feb 1, 2026	payer document
BlueCross BlueShield of South Carolina	Elivaldogene autotemcel (Skysona) Suspension for Intravenous Infusion (CAM 376) Code \| Number \| Descritpion	listed, no stance	Dec 1, 2025	payer document
BlueCross BlueShield of South Carolina	Enspryng (satralizumab) (CAM 953)	listed, no stance	Feb 1, 2026	payer document
BlueCross BlueShield of South Carolina	Exagamglogene autotemcel (Casgevy) (CAM 915)	listed, no stance	Feb 1, 2026	payer document
BlueCross BlueShield of South Carolina	Imaavy (nipocalimab) (CAM 950)	listed, no stance	Nov 1, 2025	payer document
BlueCross BlueShield of South Carolina	Kebilidi (Eladocagene Exuparvovec-tneq) (CAM 939)	listed, no stance	Sep 1, 2025	payer document
BlueCross BlueShield of South Carolina	Lyfgenia (lovotibeglogene autotemcel) (CAM 916)	listed, no stance	Apr 1, 2026	payer document
BlueCross BlueShield of South Carolina	Omidubicel-onlv (Omisirge®) (CAM 937)	listed, no stance	Jul 1, 2026	payer document
BlueCross BlueShield of South Carolina	Pharmacologic Treatment of Hereditary Transthyretin-Mediated Amyloidosis (Onpattro™/Tegsedi™/Amvuttra™) (CAM 229)	listed, no stance	Dec 1, 2025	payer document
BlueCross BlueShield of South Carolina	Ryoncil (remestemcel-L-rknd) (CAM 933)	listed, no stance	Jul 1, 2026	payer document
BlueCross BlueShield of South Carolina	Uplizna (inebilizumab-cdon) (CAM 946)	listed, no stance	May 1, 2026	payer document
Centene	Adalimumab (Humira), Adalimumab-afzb (Abrilada), Adalimumab-atto (Amjevita), Adalimumab-adbm (Cyltezo), Adalimumab- bwwd (Hadlima), Adalimumab-fkjp (Hulio), Adalimumab-adaz (Hyrimoz), Adalimumab-aacf (Idacio), Adalimumab-ryvk (Simlandi), Adalimumab-aaty (Yuflyma), Adalimumab-aqvh (Yusimry) (CP.PHAR.242)	covered if criteria are met	May 1, 2026	payer document
Centene	Aflibercept (Eylea, Eylea HD), Aflibercept-mrbb (Ahzantive), Aflibercept-abzv (Enzeevu), Aflibercept-boav (Eydenzelt), Aflibercept-yszy (Opuviz), Aflibercept-ayyh (Pavblu), Aflibercept-jbvf (Yesafili) (CP.PHAR.184) Reviews, Revisions, and Approvals \| Date \| P&T	covered if criteria are met	Feb 1, 2026	payer document
Centene	Alirocumab (Praluent) (CP.PHAR.124)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Allogeneic Hematopoietic Progenitor Cell Therapy (CP.MP.249)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Allogenic Processed Thymus Tissue-agdc (Rethymic) Reference Number: CP.PHAR.563 (CP.PHAR.563)	covered if criteria are met	Feb 1, 2026	payer document
Centene	Anakinra (Kineret) (CP.PHAR.244)	covered if criteria are met	May 1, 2026	payer document
Centene	Bimekizumab-bkzx (Bimzelx) (CP.PHAR.660)	covered if criteria are met	May 1, 2026	payer document
Centene	Brodalumab (Siliq) (CP.PHAR.375)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Bulevirtide-gmod (Hepcludex) (CP.PHAR.589)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Concizumab-mtci (Alhemo) (CP.PHAR.625)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Copper Histidinate (Zycubo) (CP.PHAR.714)	covered if criteria are met	May 1, 2026	payer document
Centene	Donidalorsen (Dawnzera) (CP.PHAR.717)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Dupilumab (Dupixent)	covered if criteria are met	May 1, 2026	payer document
Centene	Dupilumab (Dupixent) (CP.CPA.360)	covered if criteria are met	Feb 1, 2025	payer document
Centene	Dupilumab (Dupixent) (CP.PHAR.336)	covered if criteria are met	May 1, 2026	payer document
Centene	Eladocagene Exuparvovec-tneq (Kebilidi) (CP.PHAR.595)	covered if criteria are met	Feb 1, 2026	payer document
Centene	Elapegademase-lvlr (Revcovi) (CP.PHAR.419)	covered if criteria are met	May 1, 2026	payer document
Centene	Erenumab-aooe (Aimovig) (CP.CPA.349)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Erenumab-aooe (Aimovig) (CP.PHAR.128)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Erenumab-aooe (Aimovig)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Evolocumab (Repatha) (CP.PHAR.123)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Evolocumab (Repatha) (CP.CPA.269)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Faricimab-svoa (Vabysmo) (CP.PHAR.581) Policy created. \| 03.03.22 \| 05.22	covered if criteria are met	Feb 1, 2026	payer document
Centene	Filgrastim (Neupogen), Filgrastim-sndz (Zarxio), Tbo- filgrastim (Granix), Filgrastim-aafi (Nivestym), Filgrastim-ayow (Releuko), Filgrastim-txid (Nypozi), Filgrastim-laha (Filkri) (CP.PHAR.297)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Galcanezumab-gnlm (Emgality) (CP.CPA.344)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Galcanezumab-gnlm (Emgality)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Galcanezumab-gnlm (Emgality) (CP.PHAR.404)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Garadacimab-gxii (Andembry) (CP.PHAR.673)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Golimumab (Simponi, Simponi Aria, Immgolis, Immgolis Intri) (CP.PHAR.253)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Human Growth Hormone (Somapacitan, Somatrogon, Somatropin, Lonapegsomatropin-tcgd) (HIM.PA.161)	covered if criteria are met	Feb 1, 2026	payer document
Centene	Human Growth Hormone (Somapacitan, Somatrogon, Somatropin, Lonapegsomatropin-tcgd) (CP.CPA.353)	covered if criteria are met	Feb 1, 2026	payer document
Centene	Human Growth Hormone (Somapacitan, Somatrogon, Somatropin, Lonapegsomatropin-tcgd) (CP.PHAR.517)	covered if criteria are met	Feb 1, 2026	payer document
Centene	Immune Globulins (CP.PHAR.103)	covered if criteria are met	May 1, 2026	payer document
Centene	Infertility and Fertility Preservation (CP.PHAR.131)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Insulin Detemir (Levemir) (HIM.PA.171)	covered if criteria are met	Dec 1, 2025	payer document
Centene	Insulin Icodec-abae (Awiqli) (CP.PMN.309)	covered if criteria are met	May 1, 2026	payer document
Centene	Insulin Icodec-abae (Awiqli) (HIM.PA.180)	covered if criteria are met	May 1, 2026	payer document
Centene	Ixekizumab (Taltz) (CP.PHAR.257)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular Therapy (CP.MP.250)	covered if criteria are met	Jul 1, 2026	payer document
Centene	Lebrikizumab-lbkz (Ebglyss) (CP.PHAR.704)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Lebrikizumab-lbkz (Ebglyss) (CP.PCH.58)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Lerodalcibep-liga (Lerochol) (CP.PHAR.768)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Lunsotogene Parvec-cwha (Otarmeni) (CP.PHAR.757)	covered if criteria are met	Dec 1, 2025	payer document
Centene	Marnetegragene Autotemcel (Kresladi) (CP.PHAR.599)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Navepegritide (Yuviwel) (CP.PHAR.746)	covered if criteria are met	Aug 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Jan 1, 2027: conditions changed, Humana
Jan 1, 2027: conditions changed, Humana
Jan 1, 2027: conditions changed, Humana
Oct 14, 2026: conditions changed, Humana
Oct 1, 2026: PA added, Humana
Sep 3, 2026: PA added, Humana
Aug 1, 2026: PA added, Humana
Jul 1, 2026: conditions changed, CarePlus Health Plans
Jul 1, 2026: conditions changed, Humana

Medicaid fee-for-service

Prior authorization required or conditional in VT, WA.

KY: $0.00 (asc), effective Jan 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $0.00 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2022
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

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.

J3590 Unclassified biologics