CurrentMass General Brigham Health PlanPolicy N/A

Zurzuvae (zuranolone)

Pharmacy benefit prior authorization and quantity limit policy for Zurzuvae (zuranolone) for treatment of postpartum depression in adults, including initial and continuation criteria, quantity limits, and approval durations. Applies to Commercial/Exchange plans; excludes MassHealth UPPL.

Policy Summary

PayerMass General Brigham Health Plan

PolicyZurzuvae (zuranolone)

Policy CodePolicy N/A

Change TypeRevised (language updates)Created 02/14/2024

Effective DateNov 1, 2025

Next Review Date

Key ActionPrior authorization required for Zurzuvae under the pharmacy benefit; requests must meet initial or continuation criteria or qualify under 'members new to plan' exception.

SourceLink

POLICY UPDATE CHANGES

Updated language for members who are new to the Plan; updated verbiage for specialist prescriber and changed 'medical records' to 'documentation.'

Policy originally created and reviewed at Feb P&T, effective 03/01/2024.

14Initial/Reauthorization approval days

28Max tablets per 14 days (20mg & 25mg)

14Max tablets per 14 days (30mg)

12Postpartum eligibility window (months)

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Coverage Summary

Coverage stance: covered_with_criteria for the indication of postpartum depression (PPD) in adults. This policy governs the pharmacy benefit and requires prior authorization with specified quantity limits for Zurzuvae (zuranolone).

Applicability: Applies to Commercial/Exchange plans and does not apply to MassHealth UPPL.

Scope summary: Prior authorization and quantity limit policy for Zurzuvae for treatment of postpartum depression in adults, including initial and continuation criteria, a 12‑month postpartum eligibility window (date of delivery required), and approval durations consistent with policy effective 11/01/2025.

Surface thresholds

Age>= 18 years

Postpartum window<= 12 months from date of delivery (date of delivery required)

Gap for reauthorization>= 45 days since last day of treatment

Postpartum eligibility window: 12 months12 months

Initial Therapy Criteria

Exceptions for Members New to the Plan

Continuation Therapy Criteria (Reauthorization)

Provider Actions & Requirements

Prior Authorization

Prior Authorization Required

Prior authorization required for Zurzuvae under the pharmacy benefit; requests must meet initial or continuation criteria or qualify under "members new to plan" exception.

Documentation Required

Document date of delivery and pregnancy status

Prescribers must provide date of delivery to confirm <=12 months postpartum and document that member is not currently pregnant.

Documentation Required

Specialist prescriber or consultation required

Medication must be prescribed by or in consultation with a specialist (e.g., obstetrician-gynecologist/family medicine or psychiatrist); documentation of consultation should be provided.

Applicable Codes & Plan Applicability

Benefit / Program Applicabilitymixed

Commercial/Exchange	Plan applicability (checked)
MassHealth UPPL	Plan applicability (not checked)

Clinical Evidence & References

Prescribing information reference: Zurzuvae (zuranolone) [prescribing information], Biogen, Inc.; July 2024.

Background

Drug class: Zurzuvae (zuranolone) is a GABA‑A receptor positive modulator indicated for the treatment of postpartum depression in adults.

Policy scope: This is a pharmacy benefit prior authorization and quantity limit policy that applies specifically to treatment of postpartum depression within 12 months of delivery (date of delivery required). The policy includes initial authorization criteria, an exception pathway for members new to the plan, and reauthorization/continuation criteria.

Key operational notes: Prior authorization is required; initial approvals and reauthorizations are granted for 14 days, and quantity limits are set at 28 tablets per 14 days for 20mg and 25mg strengths and 14 tablets per 14 days for the 30mg strength.

Members new to the plan: members enrolled in the plan for less than or equal to 90 days.

Revision History

2024-02-14created

Policy originally created and reviewed at Feb P&T; effective 03/01/2024.

2025-11-01revisedLatest

Reviewed and updated at August P&T; updated language for members who are new to the Plan, updated verbiage for specialist prescriber, and changed 'medical records' to 'documentation.'