Ledipasvir/Sofosbuvir — Blue Cross Blue Shield of Alabama

hepatitis C genotype 1, 4, 5, or 6 including HCV/HIV co-infection

Preferred products

The patient has a diagnosis of hepatitis C genotype 1, 4, 5, or 6
The prescriber has provided the patient’s baseline HCV RNA level if patient has genotype 1
ONE of the following: patient is treatment naive OR previously treated with peg-interferon and ribavirin with or without an HCV protease inhibitor OR has decompensated cirrhosis
The prescriber has screened for HBV and will monitor if positive
The patient’s age is within FDA labeling or supported for the indication
Step therapy requirement: one of the following must apply if preferred agents for specific factors exist — requested agent preferred OR patient treated with non-preferred agent in past 30 days OR intolerance/hypersensitivity to all preferred OR contraindication to all preferred OR supported clinical rationale
ONE of the following: prescriber is a specialist or has consulted with one OR (patient is treatment naive, no or compensated cirrhosis, requested agent supported in AASLD simplified treatment and meets AASLD simplified eligibility)
The patient has no FDA-labeled contraindications
The patient will use regimen and therapy duration consistent with Table 3 (FDA labeling) or Table 4 (AASLD guidelines)
Treatment durations per FDA/AASLD tables (8–24 weeks) apply depending on viral load, previous therapy, cirrhosis status, ribavirin eligibility, and transplant status

up to duration of treatment per Tables 3 or 4