CurrentMass General Brigham Health PlanPolicy N/A

Neurokinin 3 Receptor Antagonists (Veozah, Lynkuet)

Pharmacy benefit prior authorization and quantity limit policy governing coverage of Veozah (fezolinetant) and Lynkuet (elinzanetant) for treatment of moderate to severe vasomotor symptoms due to menopause for Mass General Brigham Health Plan commercial/exchange members.

Policy Summary

PayerMass General Brigham Health Plan

PolicyNeurokinin 3 Receptor Antagonists (Veozah, Lynkuet)

Policy CodePolicy N/A

Change TypeMaterial: added Lynkuet with sequencing requirementnon‑material wording updates

Effective DateJun 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document prior trial and failure/contraindication/intolerance to Veozah before requesting Lynkuet.

SourceLink

POLICY UPDATE CHANGES

Added Lynkuet (elinzanetant) to the policy and require trial and failure with Veozah.

Updated policy title from 'Veozah' to 'Neurokinin 3 Receptor Antagonists' and updated trial and failure verbiage for previous trial agents.

2drugs covered by policy

12 monthsapproval period

Veozah:1/day; Lynkuet:2/dayquantity limits

Commercial/Exchange

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.

Coverage Criteria for Neurokinin 3 Receptor Antagonists

Initial authorization

Authorization may be granted when ALL of the following criteria are met:

Primary coverage criteria: Requested drug is being prescribed for the treatment of moderate to severe vasomotor symptoms due to menopause

Prior trial requirement: Trial and failure, contraindication, or intolerance to another medication for the treatment of vasomotor symptoms (e.g., hormone replacement therapy, SSRI, etc.)

Lynkuet-specific sequencing: For requests for Lynkuet (elinzanetant): member has had a trial failure, contraindication, or intolerance to Veozah (fezolinetant)

Reauthorization criteria

Continuation of therapy — reauthorization may be granted when ALL of the following are met:

Clinical response: Member has achieved or maintained a positive clinical response

Periodic reevaluation: Member has been re-evaluated periodically to determine if treatment is still necessary

Approval and reauthorization durations: initial approvals and reauthorizations will be granted for 12 months

There are no specialty restrictions specified for this policy; it applies to the pharmacy benefit prior authorization program for eligible members. Initial approvals and reauthorizations are granted for 12 months, and quantity limits are applied as specified in the policy (see quantity limits for each drug).

Provider Actions, Documentation, and Authorization Rules

Prior Authorization

Prior Authorization and Reauthorization Requirements

Prior authorization is required for these products. Authorization may be granted when the clinical criteria are met; reauthorization requires documentation of continued benefit and periodic re-evaluation.

Prior authorization program applies (commercial/exchange plans).
Reauthorization required: documentation of positive clinical response and periodic re-evaluation.
New members (coverage effective date ≤ 90 days): submit medical records documenting current treatment with the requested drug (exclude samples or manufacturer patient assistance program supplies).

Denial Risk

Potential Denial Triggers

Common reasons claims or authorizations are denied. Review and include required documentation at time of request to avoid delays.

Drug Definitions

Veozah (fezolinetant) — NK3 receptor antagonist

Generic nameFezolinetant

Brand nameVeozah

MechanismNeurokinin 3 (NK3) receptor antagonist

IndicationTreatment of moderate to severe vasomotor symptoms due to menopause

Plan applicabilityCommercial/Exchange members (policy effective 06/01/2026)

Lynkuet (elinzanetant) — NK1 and NK3 receptor antagonist

Generic nameElinzanetant

Background and Clinical Context

Lynkuet (elinzanetant) and Veozah (fezolinetant) are oral neurokinin receptor antagonists indicated for the treatment of moderate to severe vasomotor symptoms due to menopause. Veozah is a neurokinin 3 (NK3) receptor antagonist, while Lynkuet antagonizes both neurokinin 1 (NK1) and neurokinin 3 (NK3) receptors. These agents are included in the policy to manage menopausal vasomotor symptoms with specified prior authorization and sequencing requirements.

Policy Revision History and Changes

2026-03-11revisionLatest

Policy reviewed and updated at March P&T: title changed from 'Veozah' to 'Neurokinin 3 Receptor Antagonists'; trial and failure verbiage for prior agents updated; Lynkuet (elinzanetant) added with requirement for prior trial/failure/contraindication/intolerance to Veozah; effective date set to 2026-06-01.

2023-12-13creation

Policy created for December P&T with original effective date 2024-02-01.