Zorbtive — Highmark
Short Bowel Syndrome
Initial criteria
- Diagnosis of short bowel syndrome
- Receiving optimal management for short bowel syndrome including specialized nutritional support
Reauthorization criteria
- Experienced increase in weight from baseline OR decrease in parenteral/intravenous nutrition requirement from baseline
- Continues to be dependent on parenteral/intravenous nutrition support
Approval duration
Initial: 4 weeks; Reauth: 3 months