ModifiedColorado Rocky Mountain Health PlansPolicy 2025 P 2312-4

Pa Med Nec Lynkuet Veozah

Defines prior authorization and medical necessity criteria for initial and reauthorization coverage of Lynkuet (elinzanetant) and Veozah (fezolinetant) for moderate to severe vasomotor symptoms due to menopause, including hepatic laboratory testing requirements and authorization durations.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyPa Med Nec Lynkuet Veozah

Policy CodePolicy 2025 P 2312-4

Change TypeMaterial modifications (hepatic testing added; Lynkuet added)

Effective DateMay 15, 2026

Next Review Date

Key ActionPrior authorization is required and will be approved only when initial or reauthorization criteria are met; authorization will be issued for 12 months.

SourceLink

POLICY UPDATE CHANGES

Added criteria for hepatic laboratory tests and updated references.

Annual review and addition of Lynkuet (elinzanetant) to the program.

2Medications covered

12mAuthorization duration

baseline+periodicHepatic testing requirement

Coverage Summary

Defines prior authorization and medical necessity criteria for initial and reauthorization coverage of Lynkuet (elinzanetant) and Veozah (fezolinetant) for moderate to severe vasomotor symptoms due to menopause. Initial approval requires diagnosis of vasomotor symptoms, documentation of failure/contraindication/intolerance to at least one hormonal or non-hormonal therapy after a 30-day trial, and baseline hepatic laboratory tests prior to initiation. Reauthorization requires documentation of clinical benefit and periodic hepatic laboratory testing during therapy. Authorization will be issued for 12 months.

Provider Actions & Documentation Requirements

Prior Authorization

Prior authorization required

Prior authorization is required and will be approved only when initial or reauthorization criteria are met; authorization will be issued for 12 months.

Documentation Required

Document prior therapy trial

Document history of failure, contraindication, or intolerance to at least one hormonal or non-hormonal therapy after a 30-day trial for initial approval.

Documentation Required

Baseline hepatic testing

Obtain and document baseline hepatic laboratory tests prior to initiation to rule out underlying liver disease.

Documentation Required

Periodic hepatic monitoring on therapy

Document periodic hepatic laboratory evaluations during therapy to monitor for liver injury for reauthorization.

Clinical Evidence & References

References: Package inserts — Lynkuet (Bayer), October 2025; Veozah (Astellas), December 2024; and a 2023 review article: Khan SJ et al., Int J Womens Health. 2023;15:273-87.

Note: Veozah has been associated with reports of hepatotoxicity in post-marketing studies; reported liver injury generally resolves after discontinuation of Veozah, prompting recommendations for baseline and periodic hepatic laboratory monitoring.

Background

Lynkuet (elinzanetant) and Veozah (fezolinetant) are indicated for the treatment of moderate to severe vasomotor symptoms due to menopause. Veozah has been associated with reports of hepatotoxicity in post-marketing experience; therefore, obtain and document baseline hepatic laboratory tests prior to initiation and perform periodic hepatic laboratory testing during therapy to monitor for liver injury.

Revision History

11/2024updated_references

Updated references (annual review).

12/2024added_requirement

Added criteria for hepatic laboratory tests (baseline hepatic laboratory tests should be evaluated prior to initiation due to Veozah-associated hepatotoxicity).

12/2025material_revisionLatest

Annual review and addition of Lynkuet (elinzanetant) to the program; updated references.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyPa Med Nec Lynkuet Veozah

Policy CodePolicy 2025 P 2312-4

Change TypeMaterial modifications (hepatic testing added; Lynkuet added)

Effective DateMay 15, 2026

Next Review Date

Key ActionPrior authorization is required and will be approved only when initial or reauthorization criteria are met; authorization will be issued for 12 months.

SourceLink

On This Page

OpenPayer

Pa Med Nec Lynkuet Veozah

Coverage Summary

Initial Therapy Criteria

Continuation / Reauthorization Criteria

Provider Actions & Documentation Requirements

Applicable Codes

Clinical Evidence & References

Background

Revision History