ABACAVIR/DOLUTEGRAVIR/LAMIVUDINE (TRIUMEQ 600 MG-50 MG-300MG TAB) - Please visit the link below if you require our standard special authorization form:

• combined use of more than one biologic DMARD will not be reimbursed) Claim notes: • Must be prescribed by a rheumatologist or internist • Approvals will be for a maximum of 40mg every two weeks • Initial Approval: 6 months. [...] Claim Notes: • The patient must be under the care of a physician experienced in the diagnosis and treatment of Parkinson’s disease (PD). [...] For adolescent or adult patients in whom epiphyseal closure has occurred and who met the listingcriteria above, treatment should be discontinued if any of the following occur: • hyperparathyroidism, or • nephrocalcinosis, or • evidence of fracture or pseudofracture based on radiographic assessment. [...] Treatment should be discontinued if there is evidence of; • Sustained loss of virologic suppression (as defined above); OR • Development of resistance to, adverse events leading to lack of tolerability of, and/or lack of adherence to either component of the drug regimen; Claim Notes: • The patient must be under the care of a practitioner experienced in the care of patients with HIV. [...] Advanced Hepatocellular Carcinoma For the second-line treatment of adult patients with unresectable hepatocellular carcinoma who meet all of the following criteria: • Disease progression on sorafenib or lenvatinib • Child-Pugh class status of A • ECOG performance status of 0 or 1 Renewal Criteria: • Written confirmation that the patient has responded to treatment and continues to experience clinic.