Medicare AdvantagePrior AuthMedium impact
Zurzuvae® (zuranolone) (New)
Humana·OB-GYN, Psychiatry·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has established a new prior authorization requirement for Zurzuvae® (zuranolone), a novel 14-day treatment for postpartum depression. Effective January 1, 2026, all prescriptions require approval based on five clinical criteria including DSM-5 diagnosis confirmation, symptom onset timing, treatment within one year postpartum, and non-pregnancy status. Prior authorizations are approved for 30-day periods with renewal capability.
Action Required
By December 15, 2025: Billing team must implement prior authorization workflow for Zurzuvae prescriptions in billing system. Update OB-GYN providers and clinic staff that ALL Zurzuvae requests require prior auth submission to Humana before dispensing. Create verification checklist confirming: (1) member age ≥18, (2) documented major depressive episode with severity scale score (HAM-D, MADRS, or PHQ-9), (3) symptom onset in 3rd trimester or within 4 weeks postpartum, (4) member not pregnant, (5) only one 14-day course per episode. Set internal tracking for initial 30-day approval period and renewal submissions. Failure to obtain prior auth will result in claim denials. Communicate black box warning to providers regarding CNS depressant effects and driving restrictions.