Mavyret (glecaprevir/pibrentasvir) — Blue Cross Blue Shield of Illinois
Hepatitis C genotype 1 or 4
Preferred products
- Epclusa (sofosbuvir/velpatasvir)
- Mavyret (glecaprevir/pibrentasvir)
- Zepatier (elbasvir/grazoprevir)
- Harvoni (ledipasvir/sofosbuvir)
Initial criteria
- The patient has a diagnosis of hepatitis C genotype 1 or 4 AND
- If genotype 1, prescriber has provided subtype AND
- If subtype 1a, prescriber has tested for NS5A polymorphisms