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Sofosbuvir/Velpatasvir — Blue Cross Blue Shield of Montana

hepatitis C genotype 1 or 4

Preferred products

  • Epclusa (sofosbuvir/velpatasvir)
  • Mavyret (glecaprevir/pibrentasvir)

Initial criteria

  • The patient has a diagnosis of hepatitis C genotype 1 or 4 AND
  • If genotype 1, the prescriber has provided the patient’s subtype AND
  • If the subtype is 1a, the prescriber has tested for NS5A polymorphisms