Anthem Blue Cross (HMO, PPO, EPO)
Symtuza (darunavir-cobi-emtri-tenof ala)
Drugs for Infections : Drugs for Viral Infections
  • Step Therapy: Antiviral: HIV:
    ST Single Generic


  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on Quantity drug coverage click HERE;
  • Antiviral: HIV:
    Duration: 1 year(s)
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Restriction to use in combo with other ARVs: No
    Documented Viral Load Assay Required for PA Renewals: No
    Documented Diagnosis: No
    Restriction to Use For Active HIV Indication Only: No
    Restriction to Use For PrEP Indication Only: No

  • Prior Authorization: Antiviral: HIV:
    Duration: 1 year(s)

  • Quantity Limit: 1 tablet per 1 day(s).
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