CurrentAvMedPolicy N/A

Vorapaxar (Zontivity) prior authorization

Defines pharmacy prior authorization clinical criteria and required documentation for coverage of Zontivity (vorapaxar). Applies to prescribers seeking prior authorization through AvMed for this specialty antiplatelet agent.

Policy Summary

PayerAvMed

PolicyVorapaxar (Zontivity) prior authorization

Policy CodePolicy N/A

Change TypeRoutine review

Effective DateNov 24, 2014

Next Review Date

Key ActionPrescribing physician must complete and sign the prior authorization form and submit all required documentation to avoid delay or denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All criteriaAll listed criteria must be met for approval

Not for monotherapyZontivity must not be used as monotherapy

Medically Necessary / Prior Authorization Criteria

All of the following must be met for approval. All documentation (including labs or chart notes if required) must be submitted or request will be denied.

ALL of the following

Prescriber specialty is vascular specialist or cardiologist
Prescriber must be one of the listed specialties (checkboxes provided on form).
Indication
- Patient has had a myocardial infarction (MI)
  Checkbox on form; presence of MI is required as part of indication selection.
- Patient has peripheral arterial disease (PAD)
  Form asks whether patient has PAD.

Policy Summary

PayerAvMed

PolicyVorapaxar (Zontivity) prior authorization

Policy CodePolicy N/A

Change TypeRoutine review

Effective DateNov 24, 2014

Next Review Date

Key ActionPrescribing physician must complete and sign the prior authorization form and submit all required documentation to avoid delay or denial.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Required Provider Actions and Documentation

Prior Authorization

Complete and sign prior authorization form

Prescribing physician must sign and clearly print their name on the prior authorization request; preprinted stamps are not valid. All required sections of the form must be completed; incomplete, incorrect, or illegible information can delay the authorization process or result in denial.

Documentation Required

Submit documentation for criteria

All documentation supporting the clinical criteria — including labs or chart notes when required — must be submitted with the request or the request will be denied. Previous therapies will be verified through pharmacy paid claims or by submitted chart notes.

Denial Risk

Sample initiation not acceptable

Initiation of therapy with samples does not satisfy step edit or prior authorization requirements and may lead to denial of coverage.

Clinical and Policy Background

Vorapaxar (Zontivity) is an oral antiplatelet agent indicated to reduce thrombotic cardiovascular events in selected patients with a history of myocardial infarction (MI) or with peripheral arterial disease (PAD). The prior authorization form and clinical criteria require documentation of the indication and relevant clinical history before approval.

Because of bleeding risk, the policy requires that the prescriber be a specialist (a vascular specialist or cardiologist) and explicitly excludes use in patients with a history of prior stroke, transient ischemic attack (TIA), or intracranial hemorrhage. The form also states that Zontivity is not to be used as monotherapy, and that all required sections must be completed and signed by the prescribing physician for authorization to be processed.

OpenPayer

Vorapaxar (Zontivity) prior authorization

Medically Necessary / Prior Authorization Criteria

Required Provider Actions and Documentation

Codes and Form Fields

Clinical and Policy Background

Defined Terms

At-a-Glance Key Points