Payer PolicyActive
Bezlotoxumab (Zinplava)
EVICORE-MEDICAL_DRUG-DDEFCE62
EviCore by Evernorth
Effective: December 1, 2020
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered only as a single IV dose (up to 10 mg/kg) of bezlotoxumab to reduce recurrence of C. difficile infection in patients currently receiving antibacterial therapy and at high risk for recurrence; prior receipt of bezlotoxumab is excluded. Approval requires documentation of CDI diagnosis, active antibacterial treatment, justification of high‑risk status, confirmation of no prior bezlotoxumab, patient weight, and an administration/ dosing record; approval 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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