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. [...] Discontinuation: Treatment must be discontinued if the patient does not meet all of the renewal criteria or if the patient has any of the following: • an eGFR decrease to less than 30 mL/min/1.73 m2 • the addition of other immunosuppressant agents (other than as part of the induction and maintenance regimens), corticosteroid use outside of the limits, anti–tumor necrosis factor therapy, or other b. [...] • The patient must be under the care of a specialist with expertise in the diagnosis and management of XLH. [...] 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.