CurrentCentenePolicy CP.PHAR.270

Paricalcitol Injection (Zemplar) (PDF)

Defines medical necessity criteria, prior authorization requirements, dosing limits, continuation criteria, exclusions, and coding implications for paricalcitol injection (Zemplar) for Centene-affiliated health plans across Commercial, HIM, and Medicaid lines of business.

Policy Summary

PayerCentene

PolicyParicalcitol Injection (Zemplar) (PDF)

Policy CodePolicy CP.PHAR.270

Change Type3Q 2025 annual review (revised)

Effective Date08.01.16

Next Review Date

Key ActionProvider must submit documentation (office chart notes, lab results or other clinical information) supporting that member has met all approval criteria.

SourceLink

POLICY UPDATE CHANGES

3Q 2025 annual review dated 06.26.25 with P&T Approval Date 08.25

3Q 2021 annual review added this redirection; reiterated in later reviews.

09.15.23 update, P&T Approval Date 02.24

1Covered Indication (FDA-approved)

5Initial approval criteria items

0.24Dose maximum (mcg/kg)

J2501