HIV Combinations – Expedited Authorization

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HIV Combinations - Expedited Authorization

Effective immediately, the following Washington Apple Health pharmacy programs have added expedited authorization (EA) criteria for the HIV combination drugs listed below.

  • Amerigroup
  • Coordinated Care
  • Fee-for-Service (FFS)
  • Molina
  • United Health Care

These EA’s allow pharmacies to submit a claim for continuation of therapy without a prior authorization.

Product Code Criteria

Descovy (emtricitabine/tenofovir alafenamide)

006 Continuation of pre-exposure prophylaxis (PrEP) therapy.

HIV combinations

Biktarvy® (bictegravir/ emtricitabine/tenofovir alafenamide)

Delstrigo™ (doravirine/lamivudine/tenofovir disoproxil)

Descovy® (emtricitabine/tenofovir alafenamide)

Dovato (dolutegravir/lamivudine)

efavirenz/lamivudine/tenofovir disoproxil

Juluca (dolutegravir/rilpivirine)

Symtuza® (darunavir/cobicistat/emtricitabine/tenofovir alafenamide)

Temixys™ (lamivudine/tenofovir disoproxil)

 

007

Continuation of antiviral treatment.

 

For clients enrolled in Apple Health managed care plan, contact the client’s plan.

For additional questions, email: AppleHealthPharmacyPolicy@hca.wa.gov