Sovaldi (sofosbuvir) — 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