Payer PolicyActive
Bezlotoxumab (Zinplava®)
EVICORE-MEDICAL_DRUG-C2551484
EviCore by Evernorth
Effective: October 1, 2022
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered only to reduce recurrence of Clostridioides difficile infection as the FDA‑approved single IV dose of bezlotoxumab (one infusion, up to 10 mg/kg); prior receipt of bezlotoxumab and any use outside the FDA‑approved indication are excluded. Approval requires the patient be currently receiving antibacterial therapy for CDI, be at high risk for recurrence, have not previously received bezlotoxumab, and is limited to one 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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