Medicare AdvantagePrior AuthMedium impact
Zulresso® (brexanolone) (Revised)
Humana·Psychiatry, OB-GYN, Internal Medicine·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Zulresso® (brexanolone) prior authorization policy effective February 25, 2026. The policy maintains existing coverage criteria for postpartum depression treatment in patients 15+ years old, requiring prior authorization with specific clinical criteria including documented MDD diagnosis, previous antidepressant trial or severe risk documentation, and exclusions for active psychosis, bipolar disorder, and recent suicide attempts. Approval duration remains 60 days for both initial and renewal requests.
Action Required
By February 25, 2026: Billing and authorization teams must ensure prior authorization processes are in place for all Zulresso® (brexanolone) IV infusion requests for Medicare Advantage members. Update authorization workflows to verify all six clinical criteria are met before approval: (1) member age ≥15, (2) MDD diagnosis in third trimester or within 4 weeks postpartum per DSM-5/depression rating scale, (3) documented trial/contraindication/intolerance to SSRIs, SNRIs, bupropion, or mirtazapine OR physician attestation of severity risk, (4) not pregnant and within 6 months postpartum at initiation, (5) no active psychosis or history of bipolar/schizophrenia/schizoaffective disorder, (6) no suicide attempt in current PPD episode. Configure authorization system to approve for 60-day periods. Ensure providers are aware this is a restricted medication requiring Zulresso® REMS program enrollment. Flag any requests lacking required documentation for denial. Inform clinical staff that black box warning requires continuous pulse oximetry monitoring and patient supervision with child during administration.