Mavyret — Blue Cross Blue Shield of Kansas
chronic hepatitis C virus (HCV) infection genotypes 1–6
Preferred products
- Mavyret
- Epclusa
- Harvoni
- Ledipasvir/Sofosbuvir
- Sofosbuvir/Velpatasvir
- Vosevi
Initial criteria
- Diagnosis of hepatitis C genotype 1, 2, 3, 4, 5, or 6
- Patient age ≥ 3 years
- Patient has not been previously treated with the requested agent
- Patient does NOT have any FDA labeled contraindications to Mavyret
- Requested therapy duration aligns with FDA labeling based on genotype and cirrhosis status as per Table 5
Approval duration
up to duration of treatment per Table 5