Health Net
Fuzeon (enfuvirtide)
Drugs for Infections : Drugs for Viral Infections
  • Antiviral: HIV:
    Duration: 6 Month(s)
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Restriction to use in combo with other ARVs: Yes
    Documented Viral Load Assay Required for PA Renewals: No
    Supporting Documentation Requirements: Medication History
    Documented Diagnosis: Yes
    Restriction to Use For Active HIV Indication Only: No
    Restriction to Use For PrEP Indication Only: No

  • Step Therapy: Antiviral: HIV:
    ST Multiple Generics

  • Prior Authorization: Antiviral: HIV:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)

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