Vosevi — Blue Cross Blue Shield of Alabama

hepatitis C genotype 3

Preferred products

Diagnosis of hepatitis C genotype 1, 2, 3, 4, 5, or 6
AND ONE of the following: the patient is treatment naive OR previously treated only with peg‑interferon and ribavirin with or without an HCV protease inhibitor OR has decompensated cirrhosis
AND if the patient has an FDA‑labeled indication, then ONE of the following: patient’s age is within FDA labeling for the requested indication OR there is support for use for the patient’s age
AND prescriber has screened for current or prior hepatitis B viral infection
AND if screening positive, prescriber will monitor for HBV flare‑up or reactivation during and after treatment
AND if client has preferred agents for the patient’s specific factors, then ONE of the following: requested agent is preferred OR patient treated with requested non‑preferred agent in past 30 days OR patient has intolerance or hypersensitivity to ALL preferred agents OR patient has an FDA labeled contraindication to ALL preferred agents OR there is support for use of requested non‑preferred agent over preferred agents
AND ONE of the following: prescriber is (or has consulted) a specialist in gastroenterology, hepatology, or infectious disease OR ALL of the following: patient is treatment naive AND patient does NOT have cirrhosis or has compensated cirrhosis