Viekira Pak (ombitasvir/paritaprevir/ritonavir + dasabuvir) — Blue Cross Blue Shield of Kansas
Chronic hepatitis C (various genotypes)
Preferred products
- Epclusa (sofosbuvir/velpatasvir)
- Harvoni (ledipasvir/sofosbuvir)
- Ledipasvir/Sofosbuvir
- Mavyret (glecaprevir/pibrentasvir)
- Vosevi (sofosbuvir/velpatasvir/voxilaprevir)
- Zepatier (elbasvir/grazoprevir)
Initial criteria
- Target Agent will be approved when ALL of the following are met:
- Must meet the same baseline criteria as Sovaldi policy criteria (appropriate genotype, prior therapy, specialist involvement, HBV screening, no contraindications, etc.).
Approval duration
up to duration of treatment per FDA labeling