Sunlenca — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• According to the prescriber, the patient is failing a current antiretroviral regimen for HIV
• According to the prescriber, the patient has resistance to two or more agents from at least THREE of the following antiviral classes: nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, protease inhibitor, integrase strand transfer inhibitor
• The medication will be taken in combination with an optimized antiviral background regimen, including one or more other antiretroviral agents
• The medication is prescribed by or in consultation with a physician who specializes in the treatment of HIV infection

Reauthorization criteria

• The medication will continue to be taken in combination with an optimized antiviral background regimen including one or more other antiretroviral agents
• Patient has responded to a Sunlenca-containing regimen, as determined by the prescriber (examples: HIV RNA < 50 cells/mm3, HIV-1 RNA ≥ 0.5 log reduction from baseline in viral load, improvement or stabilization of CD4 T-cell count)

Approval duration

initial 6 months, reauth 1 year