STEP 1: Send the prescription, the patient’s medical and pharmacy insurance information, and the patient’s demographics to the appropriate specialty pharmacy within the ZURZUVAE network
Create the prior authorization (PA) in CoverMyMeds® or using the health plan’s specific PA form. It is essential to complete all fields in the PA and submit the PA and all required supporting documentation to the health plan.
Verify specialty pharmacy options or requirements with your patient’s insurance to prevent potential delays in the process.
When prescribing ZURZUVAE in your electronic health record, refer to this table for helpful tips.
Where can I get
ZURZUVAE?
ZURZUVAE is available through the following specialty pharmacy network†; it is not available through retail pharmacies
Accredo®
Alto Pharmacy®
CVS Specialty®
Special Care Pharmacy Services‡
Walmart Specialty Pharmacy
Get ZURZUVAE specialty pharmacy contact information
†Specialty pharmacy network as of November 2024. Individual patient insurance coverage is not guaranteed. A patient’s insurance coverage may require the use of a specific specialty pharmacy.
‡Special Care Pharmacy Services is for Puerto Rico residents only.
Ensure the PA is complete and accurate prior to submitting to the health plan, with the following information included
ICD-10 code
The correct ICD-10 code for patients diagnosed with PPD is F53.0.1§ Not using the correct code may result in delays
All patient, provider, and visit information
If required by the health plan, also include:
Previous treatments and length of trial
Relevant chart notes/documentation that support the treatment decision for ZURZUVAE
§This code is presented for informational purposes only. It is not a statement, promise, or guarantee concerning coverage and/or levels of reimbursement, payment, or charge and is not intended as a recommendation to increase or maximize reimbursement by any payer. It is the responsibility of the healthcare provider to determine the appropriate code(s) for diagnosis for service provided to his or her patient.
STEP 2: Alert your patient that they will receive 2 calls from the specialty pharmacy to confirm their insurance, contact, and shipping information
It is important your patient answers all calls† from the specialty pharmacy
- Please note that the specialty pharmacy will contact the patient twice: once to confirm their insurance and contact information and a second time after insurance approval to coordinate shipment (see step 3)
- The specialty pharmacy cannot dispense ZURZUVAE prescriptions until they have verified the delivery address for shipment and reviewed appropriate financial assistance options with the patient
- Consider suggesting that your patient add the specialty pharmacy phone number as a contact in their phone to avoid the calls going to spam
†Note: If a patient has previously opted in, the specialty pharmacy may text the patient instead of calling if the specialty pharmacy has the ability to do so.
Does ZURZUVAE have a patient support program?
ZURZUVAE For You is a patient support program to help patients navigate their ZURZUVAE treatment journey. The program provides services to patients, including Support Coordinators, who are available to provide product and disease information and answer questions.
Does ZURZUVAE offer a copay savings card for my patients?
Financial assistance programs, such as the ZURZUVAE Savings Card Program,‡ may be available to eligible adult patients with PPD who have been prescribed ZURZUVAE.
Eligible adult patients with commercial insurance may pay as little as a $0 copay for their ZURZUVAE prescription.§
‡Financial assistance for eligible patients under the ZURZUVAE Savings Card Program will be applied directly by the specialty pharmacy filling the prescription. Restrictions apply. For full terms and conditions, please see ZurzuvaeForYouTermsAndConditions.com.
§Only commercially insured patients with a valid, on-label ZURZUVAE prescription are eligible. Additional restrictions may apply.
STEP 3: Once the plan approves ZURZUVAE for your patient, the specialty pharmacy will ship the medication to their preferred address
The specialty pharmacy will contact your patient again to confirm shipment and delivery information
ZURZUVAE prior authorization denials may be successfully appealed
- If an appeal is required, refer to the sample letters of medical necessity and appeal guide for more information
- If your patient is denied a second time, potential steps may be required to obtain coverage. Contact your ZURZUVAE representative to discuss potential options for your patient
For questions or more information on patient support services, contact your ZURZUVAE representative or call 1-844-987-9882
Reference: 1. ICD-10-CM Tabular List of Diseases and Injuries. Centers for Medicare & Medicaid Services. Last updated February 1, 2024. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm. Accessed August 8, 2024.