CommercialCoverageMedium impact
Brexanolone (Zulresso) (CPB 0951, reviewed 2026-02-13)
Aetna·OB-GYN, Psychiatry, Internal Medicine·Medical Policy
Effective date
Apr 1, 2025
We identified it
Aug 12, 2026
Summary
Aetna has updated its Clinical Policy Bulletin for Brexanolone (Zulresso) to reflect that the medication was withdrawn from the U.S. market in April 2025 due to business reasons. The policy remains active for commercial plans but now documents this market withdrawal. Billing teams must understand that while the policy criteria still exist, the medication is no longer available for new treatments, and any claims submitted for this drug will likely be denied due to unavailability.
Action Required
By immediately: Billing team must update system alerts and claim rejection rules to flag any submissions for Brexanolone (Zulresso) injection (HCPCS J1632) with notification that the drug was withdrawn from market in April 2025. Update internal documentation and provider communications to reflect that Zulresso is no longer available for treatment. Do not process claims for CPT codes 96365-96368 (IV infusion administration) when linked to J1632, as the underlying medication is unavailable. Coordinate with clinical staff to ensure providers are aware this treatment option is no longer an option for postpartum depression management. Any existing precertification requests for Brexanolone should be denied with communication to providers regarding market withdrawal.