Pharmacy Prior Authorization Criteria

Zurzuvae (zuranolone)

Indications for Prior Authorization

Zurzuvae (zuranolone)

• For diagnosis of Postpartum Depression (PPD)
  Indicated for the treatment of PPD in women 18 years of age and older

Criteria

Zurzuvae

Prior Authorization

Length of Approval: 14 Day(s)

• One of the following:
• Diagnosis of moderate to severe postpartum depression (PPD)
OR
• Both of the following:
• Diagnosis of mild postpartum depression (PPD)
AND
• Trial and failure, contraindication or intolerance to at least one oral SSRI or SNRI (e.g., escitalopram, duloxetine)
AND
• Patient is 18 years of age or older
AND
• Onset of symptoms in the third trimester or within 4 weeks of delivery
AND
• Prescriber attests that the patient has been counseled and has agreed to adhere to the following: Will follow instructions to not drive or operate machinery until at least 12 hours after taking each dose of Zurzuvae for the duration of the 14-day treatment course and that patients are informed that they may not be able to assess their own driving competence or the degree of driving impairment caused by Zurzuvae

P & T Revisions

2024-09-19, 2024-01-04

References

1. Zurzuvae Prescribing Information. Biogen MA Inc. November 2023.

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Revision History

• 2024-09-19: Removal of trial requirement for moderate PPD to support formulary strategy.
• 2024-01-04: New Program

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