Ibalizumab-uiyk

This policy covers ibalizumab‑uiyk (Trogarzo) intravenous infusion for treatment of HIV‑1 in heavily treatment‑experienced adults with multidrug‑resistant virus who are failing their current antiretroviral regimen. Coverage requires documented plasma HIV‑1 RNA >1,000 copies/mL, resistance to at least one agent in three antiretroviral classes, ≥6 months of prior ART, use in combination with other antiretrovirals and FDA‑consistent dosing (2,000 mg loading dose then 800 mg every 2 weeks); non‑FDA uses, monotherapy, dosing deviations, and plan‑specific exclusions or caps are not covered.

"Therapies that are proven effective for the relevant diagnosis or procedure according to generally accepted standards of practice."

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