Subject: Xocova Limit 7513-H P06-2026

Drug

Antiviral for Post-Exposure Prophylaxis of COVID-19

XOCOVA  (ensitrelvir)

Policy:

Indications

FDA-approved Indications

Xocova is indicated for post-exposure prophylaxis of coronavirus disease 2019 (COVID-19) in adults and adolescents 12 years of age and older following contact with an individual who has COVID-19.

Initial Limit Quantity

This drug is for short-term acute use.

Drug	Limit
Xocova (ensitrelvir) 125 mg tablet	7 tablets / 30 days

Place of Service:

Outpatient

The above policy is based on the following references:

1.      Xocova [package insert]. Florham Park, NJ: Shionogi Inc.; May 2026.

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

July 26, 2026