Sovaldi (sofosbuvir) — Blue Cross Blue Shield of Montana

Preferred products

• Harvoni (ledipasvir/sofosbuvir)
• Ledipasvir/Sofosbuvir

Initial criteria

• 1. The patient has a diagnosis of hepatitis C genotype 1, 4, 5, or 6 AND
• 2. The prescriber has provided the patient’s baseline HCV RNA level if the patient has genotype 1 AND
• 3. ONE of the following:
• A. The patient is treatment naive OR
• B. The patient was previously treated with peginterferon and ribavirin with or without an HCV protease inhibitor OR
• C. The patient has decompensated cirrhosis AND
• 4. The prescriber has screened the patient for current or prior hepatitis B viral (HBV) infection

Approval duration

6 months