Description: Inj., ibalizumab-uiyk, 10 mg
Unit: 10 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 2000mg IV
• 800 mg every 2 weeks
Calculate drug reimbursement
(ASP: $5,619.25, Margin: $337.15)
# Units to bill:80
Prior auth criteria for Trogarzo may include but is not limited to:
1. The patient must be 18 years of age or older.
2. The patient must have HIV-1 infection that has been confirmed by laboratory testing.
3. The patient must have HIV-1 infection that is virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen for at least 6 months.
4. The patient must not have had any previous treatment failure with an INSTI-based regimen.
5. The patient must not have any major mutation associated with resistance to INSTI-based antiretroviral regimens.
6. The patient must not have a known hypersensitivity to Trogarzo or any of its components.
7. The patient must not have any ongoing or active drug or alcohol abuse.
8. The patient must not have any current or history of hepatitis B or C infection.
9. The patient must not have any contraindications to Trogarzo as listed in the prescribing information.
Insurance prior auth guidelines:
Trogarzo (THERATECHNOLOGIES INC.)