Vosevi (sofosbuvir/velpatasvir/voxilaprevir) — Blue Cross Blue Shield of Oklahoma

Preferred products

• Epclusa (sofosbuvir/velpatasvir)
• Harvoni (ledipasvir/sofosbuvir)
• Ledipasvir/Sofosbuvir
• Sofosbuvir/Velpatasvir
• Mavyret (glecaprevir/pibrentasvir)
• Zepatier (elbasvir/grazoprevir)

Initial criteria

• Patient has an FDA labeled diagnosis for the requested agent
• Requested agent FDA labeled for patient’s genotype
• If FDA labeled indication, ONE of: (A) Patient’s age within labeling OR (B) Support for use at patient’s age for indication
• If required by labeling, prescriber has screened for HBV and will monitor if positive
• Patient has no FDA labeled contraindications to requested agent
• Prescriber is specialist (gastroenterology, hepatology, infectious disease) or has consulted with one OR ALL: (1) Treatment naive, (2) No or compensated cirrhosis, (3) Supported in AASLD guidelines for simplified treatment, (4) Meets all simplified criteria (Adults with chronic HCV, treatment-naive, without or compensated cirrhosis, excluding cases such as ESRD, decompensated cirrhosis, pregnancy, hepatocellular carcinoma, prior liver transplant)
• If client has preferred agent(s), patient must meet one of the exceptions described under Step Therapy (e.g., tried/failed, intolerance, contraindication, etc.)

Approval duration

varies; up to treatment duration per labeling