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

Requests for renewal must include information showing the beneficial effects of the treatment, specifically: • a decrease of at least 2 points on the BASDAI scale, compared with the pre- treatment score; OR • patient and expert opinion of an adequate clinical response as indicated by a significant functional improvement (measured by outcomes such as HAQ or “ability to return to work”). [...] Hidradenitis suppurative (HS) For the treatment of patients with moderate to severe hidradenitis suppurative who have not responded to conventional therapy (including systemic antibiotics) and who meet all of the following: • A total absess and nodule count of 3 or greater • Lesions in at least two distinct anatomic areas, one of which must be Hurley Stage II or III • An inadequate response to a 9. [...] Claim Notes: • The patient must be under the care of a physician experienced in the diagnosis and treatment of Parkinson’s disease (PD). [...] 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. [...] • The patient must be under the care of a practitioner experienced in the care of patients with HIV.