Enfuvirtide (Fuzeon)

Aetna covers enfuvirtide (Fuzeon; HCPCS J1324) for HIV‑1 when the member has viremia despite ≥3 months of therapy with at least one appropriate regimen, or viremia with documented resistance or intolerance to at least one appropriate regimen, and continuation is allowed with a positive or stable virologic response. All other indications are considered experimental/investigational (including treatment‑naive patients and COVID‑19), ICD‑10 U07.1 is not covered, and use in pregnancy is not recommended except after failure of multiple ARV classes with HIV and obstetric specialist consultation.

"Background / pediatrics note: "Currently, data are insufficient to recommend use of enfuvirtide for initial therapy of children."

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