Long-Acting Injectable Antiretroviral Agents for HIV – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Apretude and Yeztugo only for HIV‑1 PrEP in HIV‑negative patients ≥35 kg (excluded for HIV treatment), Cabenuva only for virologically suppressed HIV‑1 patients (HIV‑1 RNA <50 copies/mL) who have no prior virologic failure or baseline resistance and are treatment‑ready, and Sunlenca injection only for heavily treatment‑experienced patients with documented multidrug‑resistant HIV as part of an optimized background regimen (Sunlenca excluded for virologically suppressed, ARV‑naïve, or PrEP use). Key requirements include FDA‑label dosing, specific provider attestations and laboratory documentation (negative HIV test before and with each PrEP injection; Cabenuva requires ≥3 months documented viral suppression, stability on ART, and adherence capability), prior/continuation authorizations limited to ≤12 months, and code/box‑warning constraints (Yeztugo contraindicated if HIV status unknown/positive).

"Apretude (cabotegravir): Proven to reduce the risk of sexually acquired HIV-1 infection in at-risk adults and adolescents weighing at least 35 kg. Medically necessary when used for HIV-1 pre-exposu..."