Selzentry® (maraviroc) - Prior Authorization/Notification - UnitedHealthcare Commercial Plansopen_in_new
Prior authorization policy for Selzentry (maraviroc) for UnitedHealthcare commercial plans, defining clinical criteria for approval, authorization duration, and additional clinical/billing rules.
Annual review with no changes to coverage criteria (1/2026).
Effective date updated to 4/1/2026.
Coverage Summary
Background: Selzentry (maraviroc) is a CCR5 co-receptor antagonist indicated in combination with other antiretroviral agents for treatment of CCR5-tropic HIV-1 in adults and pediatric patients weighing ≥2 kg. It is not recommended for dual/mixed- or CXCR4-tropic HIV-1. Tropism testing with a highly sensitive tropism assay is required. Coverage stance: covered_with_criteria. Scope summary: Prior authorization policy for Selzentry (maraviroc) for UnitedHealthcare commercial plans, defining clinical criteria for approval, authorization duration, and additional clinical/billing rules.
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