Apretude® (cabotegravir intramuscular injection) Medicare Advantage

Apretude® (cabotegravir IM) is covered only for preexposure prophylaxis (PrEP) to reduce sexually acquired HIV‑1 in at‑risk adults and adolescents weighing ≥35 kg and is not covered for treatment of established HIV‑1 infection. Coverage requires a documented negative HIV‑1 test within 7 days before dosing, documentation of weight and at‑risk PrEP indication, adherence to the labeled 600 mg IM regimen (initiation injections at 0 and 1 month, then 600 mg every 2 months; if an oral lead‑in is used injections must occur on the last oral day or within 3 days), compliance with applicable safety criteria, and authorization is limited to 12 months.

"Documentation that the patient is "at-risk" and is being treated for PrEP (diagnosis/clinical notes supporting PrEP indication)."

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