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Vosevi — Blue Cross Blue Shield of New Mexico

Hepatitis C virus infection (genotypes 1–6 per FDA labeling)

Initial criteria

  • Requested length of therapy does NOT exceed the length of therapy noted in Table 9 (FDA labeling) for the patient's regimen
  • Requested quantity (dose) does NOT exceed the program quantity limit

Approval duration

BCBSIL: 12 months; Others: up to duration per Table 9 (12 weeks per FDA labeling)