Payer PolicyActive
Bezlotoxumab (Zinplava)
EVICORE-MEDICAL_DRUG-9A43D7B7
EviCore by Evernorth
Effective: December 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered: a single IV dose of bezlotoxumab (Zinplava) up to 10 mg/kg to reduce recurrence of Clostridium difficile infection when given with antibacterial therapy; off‑label uses and repeat dosing are excluded. Key requirements: documented CDI diagnosis, concurrent antibacterial treatment for CDI, high risk for recurrence, no prior receipt of bezlotoxumab, and approval limited to one 10 mg/kg IV dose.
Coverage Criteria Preview
Key requirements from the full policy
"To reduce the recurrence of Clostridium difficile infection (CDI) in individuals who are receiving antibacterial drug treatment for CDI and are at a high risk for CDI recurrence."
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