We would like you to be aware of an upcoming policy update involving the HIV prescription medication, Atripla®. Starting January 1, 2019, step therapy requirements will apply to Atripla®. Additionally, Symfi™ and Symfi Lo™ are the Health Plan’s preferred alternative to Atripla and do not have any restrictions imposed on them.
SYMFI™ (efavirenz, lamivudine and tenofovir disoproxil fumarate) is indicated as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adult and pediatric patients weighing at least 40 kg. Symfi and Symfi Lo do not require prior authorization.
This formulary and policy change was reviewed and approved by our Pharmacy & Therapeutics (P&T) Committee, which is comprised of local physicians and pharmacists who are not employed by our Health Plan.
For commercial members, starting January 1, 2019, step therapy requirements for these medications will apply to new users only (April 1, 2019 for exchange members).
|Drug Class: HIV|
|Instead of initiating:||They must try an alternative:|
|Atripla||Symfi or Symfi Lo|
If submitting a prior authorization request for Atripla, please include all of the following relevant clinical information:
- Clinical justification as to why Symfi or Symfi Lo is not the best choice for your patient
- Rationale as to why you are requesting a step therapy protocol override is also required
If you feel that the alternative formulary medications are not the right choice for your patient, you may complete our General Exception Request Form available at Provider.ExcellusBCBS.com > Authorizations > Search Authorizations > Authorization Request Forms. The completed form should be faxed to our Pharmacy Unit for review. Submission of the prior authorization form does not guarantee coverage. We will notify you if your request is approved. As an alternative, you can submit a prior authorization request online via electronic prior authorization (ePA) by using CoverMyMeds.com or any ePA enabled EMR software.
Thank you for the quality of care and service that you provide to our members.