Zurzuvae — CareFirst (Caremark)

Initial criteria

• Member has moderate to severe post-partum depression and had a major depressive episode with onset of symptoms that began no earlier than the third trimester of pregnancy and no later than the first 4 weeks following delivery, documented by standardized rating scales that reliably measure depressive symptoms (e.g., Beck Depression Inventory [BDI], Hamilton Depression Rating Scale [HDRS], Montgomery-Asberg Depression Rating Scale [MADRS]).
• Member is 12 months postpartum or less.
• Member will not receive more than one 14-day treatment course per pregnancy/childbirth.

Approval duration

1 month