Medical Policy Updates

Notification of Policy Revisions Effective March 24, 2020 (Posted January 14, 2020)

Medical Guidelines Reason for Update
Brexanolone (Zulresso™) "Notification" Added the following criteria to "When Covered" section: "There is physician attestation that brexanolone will be administered under direct supervision of a healthcare professional at a treatment facility that is certified through the Zulresso REMS program (see Policy Guidelines)." Added the following clarification to "When Covered" section: "The infusion facility must be equipped and staffed with continuous pulse oximetry and staffed with healthcare professionals trained to handle possible excessive sedation and/or sudden loss of consciousness, including acute airway management."" Medical Director review 12/2019. Notification given 1/14/2020 for effective date 3/24/2020.