Epclusa (sofosbuvir/velpatasvir) — Blue Cross Blue Shield of Illinois

Preferred products

• Epclusa (sofosbuvir/velpatasvir)
• Harvoni (ledipasvir/sofosbuvir)
• Ledipasvir/Sofosbuvir
• Sofosbuvir/Velpatasvir
• Mavyret (glecaprevir/pibrentasvir)
• Zepatier (elbasvir/grazoprevir)

Initial criteria

• Patient has an FDA labeled diagnosis for the requested agent
• Requested agent is FDA labeled for treatment of the patient’s genotype
• Patient’s age is within or supported for FDA labeling
• HBV screening completed and monitored if positive
• Patient does not have any FDA labeled contraindications
• Prescriber is a specialist or has consulted with specialist OR patient qualifies for simplified treatment per AASLD guidelines and meets qualifying/exclusion criteria
• If the client has preferred agent(s), patient meets one of the exception conditions to use non-preferred agent

Approval duration

Duration per FDA labeling