Sovaldi (sofosbuvir) — Blue Cross Blue Shield of New Mexico
Hepatitis C virus (HCV) genotype 1, 4, 5, or 6 infection
Preferred products
- Harvoni (ledipasvir/sofosbuvir)
- Ledipasvir/Sofosbuvir
Initial criteria
- The patient has a diagnosis of hepatitis C genotype 1, 4, 5, or 6 AND
- The prescriber has provided the patient’s baseline HCV RNA level if genotype 1 AND
- ONE of the following: (A) The patient is treatment naive OR (B) Previously treated with peginterferon and ribavirin with or without an HCV protease inhibitor OR (C) The patient has decompensated cirrhosis AND
- The prescriber has screened the patient for current or prior hepatitis B viral (HBV) infection
Approval duration
6 months (BCBSIL and BCBSMT); ≥12 weeks (BCBSNM); up to duration of treatment