Sunlenca (lenacapavir®)

Sunlenca is covered only for heavily treatment‑experienced adults (≥18) with documented multidrug‑resistant HIV‑1 who are failing current antiretroviral therapy and will receive Sunlenca in combination with an optimized background regimen; it is excluded for patients <18, treatment‑naïve individuals, monotherapy use, or without the required resistance profile. Coverage requires documented resistance to ≥2 agents in at least three antiretroviral classes, prescription/consultation by an HIV specialist, initial approval for 6 months with dosing 927 mg SC (Day 1) and maintenance 927 mg every 6 months, and 12‑month reauthorization contingent on virologic response (e.g., HIV‑1 RNA <50 copies/mL or ≥0.5 log10 reduction).

"For reauthorization: Has responded to a Sunlenca-containing regimen (e."

Sign up to see full coverage criteria, indications, and limitations.