Vosevi (sofosbuvir/velpatasvir/voxilaprevir) — Blue Cross Blue Shield of Montana
hepatitis C genotype 6
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